Post written by Ahmed Altonbary, MD, FRCP, from the Department of Gastroenterology and Hepatology, Mansoura Specialized Medical Hospital, Mansoura University, Mansoura, Egypt.

We describe a case of EUS-guided ethanol ablation (EA) of metastatic functional insulinoma in a young male with recurrent attacks of hypoglycemia requiring intravenous glucose infusion.   

Management of functioning pancreatic NETs is challenging; the goal of treatment is to induce necrosis of most of the tumor cells to abate the hormonal hypersecretion with cessation of symptoms. EUS-guided EA is effective, safe, and can be an alternative for patients who are poor surgical candidates or refuse surgery. EUS can also detect small hepatic metastases missed by CT, with feasible EUS-FNB even in small lesions less than 5 mm.

The published data from 2006 on EUS-guided EA of functioning insulinomas included only 18 patients. So, it is important to learn the key technical points including the type and amount of ethanol needed for injection, the technique of injection, and how to do the procedure in a safe and effective way.

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