Intra-operative quick insulin assay to confirm complete resection of insulinomas guided by selective arterial calcium injection (SACI)

Gimm, Oliver; König, Evelyn; Thanh, Phuong Nguyen; Brauckhoff, Michael; Karges, Wölfram; Dralle, Henning

doi:10.1007/s00423-006-0144-3

Cited by 21 publications

(25 citation statements)

References 20 publications

(25 reference statements)

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“…For atypical insulinomas, preoperative localization of insulinomas by ASVS is particularly important. The accuracy of ASVS in localizing insulinomas has been reported to range from 94% to 100% [23,28] . Using ASVS, insulinomas are seen as well-defined, round or oval vascular blushes that are of increased vascularity compared with the surrounding normal pancreatic parenchyma (Figure 4).…”

Section: Medical Management Of Benign Insulinomasmentioning

confidence: 99%

“…Following biological and biochemical confirmation of an insulinoma, preoperative localization is sought using computed tomography (CT) [14][15][16] , magnetic resonance imaging (MRI) [16][17][18][19] , endoscopic ultrasonography (EUS) [20][21][22] , intra-arterial calcium stimulation test with hepatic venous sampling [23] , and/or angiography and arterial stimulation venous sampling (ASVS) [24][25][26][27][28] . Surgical resection is the primary treatment modality for insulinomas, and so accurate localization of the tumor before or during surgery is important.…”

Section: Introductionmentioning

confidence: 99%

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Diagnosis and management of insulinoma

Okabayashi¹,

Shima²,

Sumiyoshi³

et al. 2013

WJG

373

328

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Insulinomas, the most common cause of hypoglycemia related to endogenous hyperinsulinism, occur in 1-4 people per million of the general population. Common autonomic symptoms of insulinoma include diaphroresis, tremor, and palpitations, whereas neuroglycopenenic symptoms include confusion, behavioural changes, personality changes, visual disturbances, seizure, and coma. Diagnosis of suspected cases is based on standard endocrine tests, especially the prolonged fasting test. Non-invasive imaging procedures, such as computed tomography and magnetic resonance imaging, are used when a diagnosis of insulinoma has been made to localize the source of pathological insulin secretion. Invasive modalities, such as endoscopic ultrasonography and arterial stimulation venous sampling, are highly accurate in the preoperative localization of insulinomas and have frequently been shown to be superior to non-invasive localization techniques. The range of techniques available for the localization of insulinomas means that blind resection can be avoided. Intraoperative manual palpation of the pancreas by an experienced surgeon and intraoperative ultrasonography are both sensitive methods with which to finalize the location of insulinomas. A high proportion of patients with insulinomas can be cured with surgery. In patients with malignant insulinomas, an aggressive medical approach, including extended pancreatic resection, liver resection, liver transplantation, chemoembolization, or radiofrequency ablation, is recommended to improve both survival and quality of life. In patients with unresectable or uncontrollable insulinomas, such as malignant insulinoma of the pancreas, several techniques should be considered, including administration of ocreotide and/or continuous glucose monitoring, to prevent hypoglycemic episodes and to improve quality of life.

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Section: Medical Management Of Benign Insulinomasmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Diagnosis and management of insulinoma

Okabayashi¹,

Shima²,

Sumiyoshi³

et al. 2013

WJG

373

328

View full text Add to dashboard Cite

show abstract

“…When a sporadic insulinoma is not localized preoperatively, surgical exploration is indicated [3,8,9,11,47,96,111,142,145,146,148,150]. Intraoperative tumor location can require, additionally to IOUS, intraoperative insulin sampling and frozen section [163]. In rare patients with suspicion of malignant insulinoma or recurrence, a radical surgery aiming to treat either locoregional recurrence and/or LM is indicated.…”

Section: Surgery With Functional P-nets [5815111142143144]mentioning

confidence: 99%

“…Preoperative localization of which pancreatic tumors are the insulinomas is mandatory, because these patients frequently have other pancreatic NETs (which are usually non-functional) [2,11,52,142]. In these patients, preoperative intra-arterial calcium injections with hepatic venous insulin sampling as well as intraoperative insulin sampling may be required [8,11,50,107,163]. …”

Section: Surgery With Functional P-nets [5815111142143144]mentioning

confidence: 99%

ENETS Consensus Guidelines for the Management of Patients with Digestive Neuroendocrine Neoplasms: Functional Pancreatic Endocrine Tumor Syndromes

Jensen¹,

et al. 2012

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“…If an insulinoma cannot be detected by EUS, crosssectional or PET imaging, especially in the presence of multiple pNENs >1 cm, a selective arterial calcium injection (SACI) angiography can be performed to regionalize the source of insulin excess with high sensitivity and specificity of >85% (Haji et al 2000, Gimm et al 2007, Thakker et al 2012.…”

Section: :10mentioning

confidence: 99%

The future: diagnostic and imaging advances in MEN1 therapeutic approaches and management strategies

Manoharan¹,

Albers²,

Bartsch³

2017

Endocrine-Related Cancer

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Prospective randomized data are lacking, but current clinical expert guidelines recommend annual screening examinations, including laboratory assessments and various imaging modalities (e.g. CT, MRI, scintigraphy and EUS) for patients with multiple endocrine neoplasia type 1 (MEN1). Routine screening is proposed to detect and localize neuroendocrine manifestations as early as possible. The goal is timely intervention to improve quality of life and to increase life expectancy by preventing the development of life-threatening hormonal syndromes and/or metastatic disease. In recent years, some studies compared different and new imaging methods regarding their sensitivity and utility in MEN1 patients. This present article reviews the proposed diagnostic tools for MEN1 screening as well as potential future perspectives.

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Intra-operative quick insulin assay to confirm complete resection of insulinomas guided by selective arterial calcium injection (SACI)

Abstract: Pre-operatively, SACI appears to be a very sensitive localisation technique and may be most helpful in guiding the surgeon if conventional imaging techniques fail to localise the tumor. Complete removal of an insulinoma can be reliably predicted using a quick insulin assay.

Cited by 21 publications

References 20 publications

Diagnosis and management of insulinoma

Diagnosis and management of insulinoma

ENETS Consensus Guidelines for the Management of Patients with Digestive Neuroendocrine Neoplasms: Functional Pancreatic Endocrine Tumor Syndromes

The future: diagnostic and imaging advances in MEN1 therapeutic approaches and management strategies

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