Successful EUS-guided ethanol ablation of insulinoma, four-year follow-up. Case report and literature review

Abstract

Introduction: EUS-guided ethanol ablation of insulinoma is a new method of treatment of this neuroendocrine tumour. Ablation is recommended in patients who are poor surgical candidates or refuse surgery. We present a case of an 81-year-old female with symptomatic insulinoma, treated successfully with EUS-guided alcoholic ablation, along with a literature review including 28 other previously described cases. The effectiveness, safety of the therapy, and technical procedure-related issues are summarised. To the best of our knowledge, this is the first described case of successful insulinoma EUS-guided ablation in Poland. Material and methods:We searched the PubMed/Medline database to identify cases of EUS-guided alcoholic ablation. Our analysis included 14 articles (case reports or case series), with a total of 27 patients and 31 tumours described, published before February 2017. Results: The described tumours were relatively small (mean 13 mm), and the most common location was pancreatic head. The mean ethanol volume injected to the tumour was 1.8 ml and the concentration of infused alcohol varied from 95% to 98%.Side effects were observed in six cases; apart from one, they were mild and self-limiting. There was only one severe adverse event, treated conservatively with success. The median follow-up was 14.4 months (2-55 months). In all described cases ablation led to improvement of the symptoms and normalisation of glycaemia. Conclusions:The EUS-guided alcoholic ablation of insulinoma is a safe and effective method of treatment in patients who are poor surgical candidates and/or refuse surgery. The adverse effects are rare and mild and were observed when the volume of injected ethanol was equal to or above 3.0 ml. However, the data is limited, the follow-up is relatively short, and prospective studies are needed to confirm the long-term effects of treatment. The study shows also that there are important procedural differences (concentration and volume of alcohol, needle gauge, number of sessions) between the endoscopists, which should be specified. (Endokrynol Pol 2017; 68 (4): 472-479)

Interventional endoscopic ultrasound for pancreatic neuroendocrine neoplasms

“…Subsequent case reports and small case series have been published describing the use of EUS‐EA for both F‐PanNENs and NF‐PanNENs. Up to December 2019, 83 patients with 96 lesions have been treated by EUS‐EA20–42 (Table 2). The success rate was 94.7% for F‐PanNENs and between 50% and 62.5% for NF‐PanNENs (Table 3).…”

Endoscopic ultrasound-guided ethanol ablation of insulinoma

“…Considering this limitation and the patient's severity of symptoms and benign char- patient reported mild abdominal pain on the day of the procedure, and a transient, six-fold elevation of lipase activity was observed, which was normalised within 72 h. Another type of nonsurgical management of insulinoma is EUS-guided radiofrequency ablation. Both ablative therapies, namely ethanol injection and radiofrequency, seem to be effective, safe, and repeatable procedures in patients who are at increased surgical risk [1][2][3][4][5]. Mele et al reported that after an average follow-up of 16 months, the overall success rate of nonsurgical ablative treatments of insulinoma was 84% [4].…”

“…Mele et al reported that after an average follow-up of 16 months, the overall success rate of nonsurgical ablative treatments of insulinoma was 84% [4]. The longest follow-up of a patient after a successful EUS-guided ethanol ablation of insulinoma was four years [5]. It is worth highlighting that ethanol ablation is more economically beneficial than EUS-guided radiofrequency ablation.…”

EUS‐guided ethanol ablation for small pancreatic neuroendocrine neoplasm

“…To date, several case reports and a small case series of EUS‐EA have been reported, showing a success rate of 50–100% if success rate is defined as symptom disappearance in patients with functional PNEN (F‐PNEN) and radiological evidence of complete tumor ablation in patients with NF‐PNEN …”

“…To date, several case reports and a small case series of EUS-EA have been reported, showing a success rate of 50-100% if success rate is defined as symptom disappearance in patients with functional PNEN (F-PNEN) and radiological evidence of complete tumor ablation in patients with NF-PNEN. [3][4][5][6][7][8][9] As a basic method for local injection of ethanol, needle puncture is recommended at the far end of the tumor, with gradual withdrawal while injecting a small amount of ethanol. Ethanol comes out from a different puncture hole if multiple punctures are performed in the same session.…”