Endoscopic ultrasound-guided ethanol ablation of insulinoma

Zalewska, E.; Kłosowski, Przemysław; Dubowik, Michał; Pęksa, Rafał; Sworczak, Krzysztof

doi:10.5603/ep.a2020.0070

Cited by 2 publications

(7 citation statements)

References 4 publications

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“…Eleven out of 75 (15%) patients had complications following EUS-guided ablation, five (18%) after EUS-RFA 30 , 32 , 34 , 53 and six (13%) after EUS-EA. 10 , 29 , 41 , 43 , 45 , 51 All five patients in the EUS-RFA group had experienced abdominal pain, two of them developing mild acute pancreatitis, and one had severe necrotising pancreatitis. In the case of EUS-guided EA, three patients complained of abdominal pain; one had duodenal perforation with bleeding.…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…23 The 34 remaining articles were written in English. 10,16,21,22, Fifteen reports were from Europe, 10,[22][23][24][26][27][28][29][30]34,40,45,[49][50][51] nine from Asia, 25,32,33,35,37,[41][42][43]53 eight from the United States of America, 16,31,36,39,44,47,48,52 two from South America, 38,46 and one from Egypt. 21 Our comprehensive search did not identify any comparative studies (controlled); all data emerged from descriptive studies (case reports or case series).…”

Section: Search and Selectionmentioning

confidence: 99%

“…Altogether we analysed 35 articles in our systematic review. Eleven studies reported on EUS-guided RFA: 22,25,28,[30][31][32]34,40,44,50 twentythree on EUS-guided EA: 10,16,21,23,24,26,27,29,[35][36][37][38][39][41][42][43][45][46][47][48][49]51,52 and one on both techniques. 33 The total number of patients was seventy-five, of whom 26 were male, 38 female and 11 patients' gender was not reported.…”

Section: Findings Of the Systematic Reviewmentioning

confidence: 99%

“…Our results demonstrated that 21 out of 65 patients (32% of all cohort) had multiple co-morbidities, which precluded surgical intervention; however, EUS-guided RFA/EA was successful in them. 6,16,22,23,[25][26][27][28][29]31,[36][37][38][39]41,42,45,46,[48][49][50][51][52] Peri-procedural medical and dietetic management. Our current study reflected that prophylactic antibiotics were used; only four of the 35 included studies documented antibiotic use preablations.…”

Section: Efficacy Of Ablation Techniquesmentioning

confidence: 99%

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Endoscopic ultrasound-guided ethanol and radiofrequency ablation of pancreatic insulinomas: a systematic literature review

Sayed

Frim

Franklin

et al. 2021

Therap Adv Gastroenterol

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Background: 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. Methods: 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. Results: 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. Conclusions: EUS-guided ablation of insulinoma seems to be a safe and effective treatment and is an alternative to surgical resection in selected cases.

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