Insulinoma is the most common neuroendocrine neoplasm of the pancreas, characterised
by hypoglycaemic symptoms. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA)
and ethanol ablation (EUS-EA) are novel methods for treating insulinoma.We aimed to
perform a systematic review to assess the efficacy and safety of EUS-guided ablation
techniques for pancreatic insulinomas.We systematically searched for articles detailing
EUS-guided ablations of insulinomas. We performed a qualitative analysis and summarised
data on the efficacy and safety of EUS-RFA and EUS-EA techniques.In total, we identified
35 case reports and case series describing 75 patients with insulinomas treatment
with EUS-guided ablation. Twenty-seven patients were treated with EUS-RFA, 47 patients
with EUS-EA, and 1 patient received EUS-EA and EUS-RFA in the same session. In total,
84 insulinomas were ablated (EUS-RFA: 31, EUS-EA: 53). Most insulinomas were in the
head of the pancreas (40%). The clinical success rate for EUS-guided ablation techniques
was 98.5%. The median glucose level was 1.95 (Q1-Q3: 1.69-2.13) mmol/L before ablation
compared to 6.20 (Q1-Q3: 5.30-7.05) mmol/L after treatment. The median insulin and
C-peptide levels before and after RFA/EA were 230 (Q1-Q2: 120-257) pmol/L and 41 (Q1-Q2
35-42) pmol/L; 2077 (Q1-Q2 1644-2459) pmol/L and 819 (Q1-Q2 696-1072) pmol/L, respectively.
There were eleven adverse events: seven abdominal pain, two mild acute pancreatitis,
one necrotising acute pancreatitis and one local hematoma. All patients recovered,
and there were no periprocedural deaths.EUS-guided ablation of insulinoma seems to
be a safe and effective treatment and is an alternative to surgical resection in selected
cases.
