EUS-RFA for pancreatic insulinoma with a novel needle electrode

Sundeep Lakhtakia, DM, from the Asian Institute of Gastroenterology in Hyderabad, India discusses this New Methods article “EUS-guided radiofrequency ablation for management of pancreatic insulinoma by using a novel needle electrode (with videos).”

Insulinomas are one of the most common functional pancreatic neuroendocrine tumors. Surgical removal is the standard of care. However, patients who are unfit or refuse surgery need an alternative non-surgical method to alleviate their debilitating symptoms. EUS is used for insulinoma for various reasons—to localize the lesion, FNA (if required, to diagnose), tattoo to help localize it during surgery, and even ablate by injecting alcohol into it.

Figure 2. A, Abdominal contrast-enhanced CT in the arterial phase shows an enhancing lesion (insulinoma) in the pancreatic genu (arrow). B, Welldefined hypoechoic oval-shaped lesion (insulinoma) in the pancreatic genu (arrow).

This closely followed up observational study aimed to assess the feasibility of EUS-guided radiofrequency ablation (EUS-RFA) for managing patients with a symptomatic insulinoma not eligible for surgery. A novel EUS-RFA 19-gauge needle electrode was used, which was attached to a precise energy generator and an internal cooling system. EUS-guided RFA is performed under real-time visualization at 50 W to ablate pancreatic insulinoma. Three patients with a symptomatic pancreatic insulinoma underwent EUS-RFA. All had rapid symptom relief with biochemical improvement. They remained symptom free along with normal biochemistry (normal blood sugar, serum insulin and C-Peptide levels) maintained at one year of follow-up. There were no procedure-related adverse events.

EUS guided RFA with the novel needle type device can be considered in select patients with a symptomatic pancreatic insulinoma for their beneficial effect without adverse events. However, assessment of the safety profile requires larger prospective trials.

Read the abstract for this article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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