The role of endoscopic ultrasound (EUS) in the diagnosis and treatment of insulinoma: A systematic review of the literature

Elsayed, Ghassan; Frim, Levente; Franklin, Jamie; McCrudden, Raymond; Gordon, Charles; Al-Shamma, S; Kiss, Szabolcs; Erőss, Bálint; Hegyi, Péter

doi:10.1016/j.pan.2021.05.154

Cited by 1 publication

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“…In contrast, ethanol injection or other minimally invasive procedures to target insulinomas may harbor a much lower complication risk. [24] In this study, no patient in the ethanol group had a post-interventional complication higher than Clavien-Dindo I (if re-interventions are excluded). Interestingly, one patient of this cohort who had previously undergone tumor enucleation presented with multiple tumors and was diagnosed via histology with insulinomatosis (MEN was excluded).…”

Section: Accepted Manuscriptmentioning

confidence: 59%

“…Given, the high effectiveness of ethanol injection in hypoglycemia resolution (even if multiple injections become necessary) and less severe complications, ethanol injection appears to represent a valuable alternative in selected patients. [24] Even though two of nine patients had to be injected twice, both were free of symptoms after the second injection. One of them was already diagnosed with a residual tumor directly after the procedure by contrast-enhanced percutaneous sonography but refused another ethanol instillation for lack of symptoms at that time.…”

Section: Accepted Manuscriptmentioning

confidence: 97%

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Endoscopic ultrasound-guided ethanol ablation versus surgical resection of insulinomas

Jürgensen,

Eckart,

Haberbosch

et al. 2023

Ultraschall Med

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Purpose: Insulinoma is a rare tumor of the pancreas that can lead to hypoglycemia. To date, standard therapy is surgical resection. After first case report of successful endoscopic ultrasound-guided (EUS) ethanol injection 16 years ago, the need of establishing an alternative treatment method is unchanged facing the high morbidity rates of surgery and its inapplicability in some patients. Materials and Methods: Here, we provide retrospective data from 33 insulinoma patients that were treated at our center between 2010 and 2021. Of these, 9 patients were treated with EUS-guided ethanol injection and 24 underwent pancreatic surgery. Results: The ethanol group was older (ethanol: mean±SE 67.8±11.2 years vs. surgery: 52.3±15.7, p=0.014) with a higher Charlson Comorbidity Index (3.0 (1.0;4.0) vs. 1.0 (0.0;2.0), p=0.008). Lowest glucose values were similar between groups before (ethanol: 2.09±0.17 mmol/l vs. surgery: 1.81±0.08, p=0.158) and after (4.95±0.74 vs. 5.41±0.28, p=0.581) the respective treatments. Complications occurred more frequently in the surgery group (11 % vs. 54 %, p=0.026). One patient after prior partial pancreatectomy died postoperatively. Hospitalization time was significantly shorter in the ethanol group (4.78±0.78 days vs. 19.88±4.07, p<0.001). Conclusion: EUS-guided ethanol injection can be similarly effective for the treatment of hyperinsulinemic hypoglycemia compared with pancreatic surgery but seems to be associated with less severe complications. This implies the need for prospective randomized trials in insulinoma patients with low risk for malignancy. Ziel: Insulinome sind seltene Tumore des Pankreas, die zu Hypoglykämien führen können. Die chirurgische Resektion ist aktuell Standardtherapie. Nach der ersten Fallbeschreibung einer erfolgreichen EUS-gesteuerten Alkoholinjektion vor 16 Jahren besteht unverändert der Bedarf einer Behandlungsalternative angesichts der hohe operativen Morbidität und der fehlenden Anwendbarkeit bei einigen Patienten. Material und Methode: Wir zeigen die retrospektiven Daten von 33 Insulinom-Patienten, die in unserem Zentrum zwischen 2010 und 2021 behandelt wurden. Von diesen wurden 9 Patienten durch EUS-geführte Alkohol-Injektion und 24 durch Pankreas-Chirurgie behandelt. Ergebnisse: Die Alkohol-Therapie-Gruppe war älter (Alkohol: median±SE 67.8±11.2 Jahre vs. Chirurgie: 52.3±15.7, p=0.014) mit einem höheren Charlson Comorbidity Index (3.0 (1.0;4.0) vs. 1.0 (0.0;2.0), p=0.008). Die niedrigsten Blutzucker waren in beiden Gruppen gleich vor (Alkohol: 2.09±0.17 mmol/l vs. Chirurgie: 1.81±0.08, p=0.158) und nach (4.95±0.74 vs. 5.41±0.28, p=0.581) den jeweiligen Behandlungen. Komplikationen traten häufiger in der Chirurgie-Gruppe auf (11 % vs. 54 %, p=0.026). Ein Patient starb nach partieller Pankreatektomie postoperativ. Die Krankenhausverweildauer war signifikant kürzer in der Alkohol-Gruppe (4.78±0.78 Tage vs. 19.88±4.07, p<0.001). Schlussfolgerungen: Die EUS-gesteuerte Alkoholinjektion kann gleich effektiv sein wie Chirurgie für die Behandlung der hyperinsulinämen Hypoglykämie, scheint aber mit weniger schweren Komplikationen assoziiert zu sein. Hieraus ergibt sich die Notwendigkeit für randomisierte Studien bei Insulinom-Patienten mit niedrigem Malignitäts-Risiko.

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Section: Accepted Manuscriptmentioning

confidence: 59%

Section: Accepted Manuscriptmentioning

confidence: 97%