EUS-guided radiofrequency ablation as a minimally invasive treatment for insulinomas - a single center experience

CONTEXT: Insulinomas, although rare, are among the most common functional pancreatic neuroendocrine neoplasms (pNENs), causing debilitating and recurrent hypoglycemic episodes and severely affecting quality of life.

OBJECTIVE: To evaluate endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) as a novel and minimally invasive treatment for insulinomas.

DESIGN: Retrospective cohort study between 2022 and 2025. Mean follow-up duration was 15.5 months.

SETTING: A single tertiary care center experience.

PATIENTS: We retrospectively identified patients with a suspicion of insulinomas (based on a positive fasting test and imaging) who underwent EUS-RFA. Lesions considered for RFA were biopsy-proven pNENs with a Ki67 index <10%, and <25 mm in size.

INTERVENTION: All patients were hospitalized for 24 hours and EUS-RFA was conducted under general anesthesia using a dedicated EUS-RFA needle and under direct ultrasound guidance.

MAIN OUTCOME MEASURES: Clinical success (symptom improvement with a documented increase in blood glucose) and safety.

RESULTS: 17 patients were identified and included. The mean age was 60.1 years and 53% were male. Normoglycemia was achieved after a single EUS-RFA session in 11 patients (64.7%), while 6 patients (35.3%) required a second EUS-RFA. The overall clinical success rate was 100% (n=17/17; 95% CI: 80.4-100.0%). Four adverse events were observed in 23 procedures (17.4%), two mild and two moderate (8.7%).

CONCLUSIONS: EUS-RFA appears to provide complete symptom resolution and demonstrates a favorable safety profile compared to conventional surgery. However, the long-term efficacy of EUS-RFA remains to be determined.