Endoscopic Ultrasound-guided Radiofrequency Ablation Versus Surgical Resection for Treatment of Pancreatic Insulinoma

Stefano Francesco Crinò; Bertrand Napoleon; Antonio Facciorusso; Sundeep Lakhtakia; Ivan Borbath; Fabrice Caillol; Khanh Do-Cong Pham; Gianenrico Rizzatti; Edoardo Forti; Laurent Palazzo; Arthur Belle; Peter Vilmann; Jean Luc van Laethem; Mehdi Mohamadnejad; Sebastien Godat; Pieter Hindryckx; Ariel Benson; Matteo Tacelli; Germana De Nucci; Cecilia Binda; Bojan Kovacevic; Harold Jacob; Stefano Partelli; Massimo Falconi; Roberto Salvia; Luca Landoni; the ERASING study collaborators; Sergio Alfieri; Paolo Giorgio Arcidiacono; Marianna Arvanitakis; Anna Battistella; Laura Bernadroni; Lene Brink; Marcello Cintolo; Maria Cristina Conti Bellocchi; Maria Vittoria Davì; Sophie Deguelte; Pierre Deprez; Jaques Deviere; Jacques Ewald; Carlo Fabbri; Giovanni Ferrari; Raluca Maria Furnica; Armando Gabbrielli; Rodrigo Garcés-Duran; Marc Giovannini; Tamas Gonda; Joan B. Gornals; Mariola Marx; Michele Mazzola; Massimiliano Mutignani

doi:10.1016/j.cgh.2023.02.022

Endoscopic Ultrasound-guided Radiofrequency Ablation Versus Surgical Resection for Treatment of Pancreatic Insulinoma

Stefano Francesco Crinò^*, Bertrand Napoleon, Antonio Facciorusso, Sundeep Lakhtakia, Ivan Borbath, Fabrice Caillol, Khanh Do-Cong Pham, Gianenrico Rizzatti, Edoardo Forti, Laurent Palazzo, Arthur Belle, Peter Vilmann, Jean Luc van Laethem, Mehdi Mohamadnejad, Sebastien Godat, Pieter Hindryckx, Ariel Benson, Matteo Tacelli, Germana De Nucci, Cecilia BindaBojan Kovacevic, Harold Jacob, Stefano Partelli, Massimo Falconi, Roberto Salvia, Luca Landoni, the ERASING study collaborators, Sergio Alfieri, Paolo Giorgio Arcidiacono, Marianna Arvanitakis, Anna Battistella, Laura Bernadroni, Lene Brink (Member of study group), Marcello Cintolo, Maria Cristina Conti Bellocchi, Maria Vittoria Davì, Sophie Deguelte, Pierre Deprez, Jaques Deviere, Jacques Ewald, Carlo Fabbri, Giovanni Ferrari, Raluca Maria Furnica, Armando Gabbrielli, Rodrigo Garcés-Duran, Marc Giovannini, Tamas Gonda, Joan B. Gornals, Mariola Marx, Michele Mazzola, Massimiliano Mutignani

^*Corresponding author for this work

Gastroenterology

12 Citations (Scopus)

Abstract

BACKGROUND & AIMS: Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is emerging as a safe and effective treatment for pancreatic neuroendocrine tumors. We aimed to compare EUS-RFA and surgical resection for the treatment of pancreatic insulinoma (PI).

METHODS: Patients with sporadic PI who underwent EUS-RFA at 23 centers or surgical resection at 8 high-volume pancreatic surgery institutions between 2014 and 2022 were retrospectively identified and outcomes compared using a propensity-matching analysis. Primary outcome was safety. Secondary outcomes were clinical efficacy, hospital stay, and recurrence rate after EUS-RFA.

RESULTS: Using propensity score matching, 89 patients were allocated in each group (1:1), and were evenly distributed in terms of age, sex, Charlson comorbidity index, American Society of Anesthesiologists score, body mass index, distance between lesion and main pancreatic duct, lesion site, size, and grade. Adverse event (AE) rate was 18.0% and 61.8% after EUS-RFA and surgery, respectively (P < .001). No severe AEs were observed in the EUS-RFA group compared with 15.7% after surgery (P < .0001). Clinical efficacy was 100% after surgery and 95.5% after EUS-RFA (P = .160). However, the mean duration of follow-up time was shorter in the EUS-RFA group (median, 23 months; interquartile range, 14-31 months vs 37 months; interquartile range, 17.5-67 months in the surgical group; P < .0001). Hospital stay was significantly longer in the surgical group (11.1 ± 9.7 vs 3.0 ± 2.5 days in the EUS-RFA group; P < .0001). Fifteen lesions (16.9%) recurred after EUS-RFA and underwent a successful repeat EUS-RFA (11 patients) or surgical resection (4 patients).

CONCLUSION: EUS-RFA is safer than surgery and highly effective for the treatment of PI. If confirmed in a randomized study, EUS-RFA treatment can become first-line therapy for sporadic PI.

Original language	English
Journal	Clinical Gastroenterology and Hepatology
ISSN	1542-3565
DOIs	https://doi.org/10.1016/j.cgh.2023.02.022
Publication status	Accepted/In press - 2023

Keywords

Acute pancreatitis
Hypoglycemia
Insulin
Neuroendocrine Tumor
Pancreatic Fistula

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10.1016/j.cgh.2023.02.022

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Crinò, S. F., Napoleon, B., Facciorusso, A., Lakhtakia, S., Borbath, I., Caillol, F., Do-Cong Pham, K., Rizzatti, G., Forti, E., Palazzo, L., Belle, A., Vilmann, P., van Laethem, J. L., Mohamadnejad, M., Godat, S., Hindryckx, P., Benson, A., Tacelli, M., De Nucci, G., ... Mutignani, M. (Accepted/In press). Endoscopic Ultrasound-guided Radiofrequency Ablation Versus Surgical Resection for Treatment of Pancreatic Insulinoma. Clinical Gastroenterology and Hepatology. https://doi.org/10.1016/j.cgh.2023.02.022

Crinò, SF, Napoleon, B, Facciorusso, A, Lakhtakia, S, Borbath, I, Caillol, F, Do-Cong Pham, K, Rizzatti, G, Forti, E, Palazzo, L, Belle, A, Vilmann, P, van Laethem, JL, Mohamadnejad, M, Godat, S, Hindryckx, P, Benson, A, Tacelli, M, De Nucci, G, Binda, C, Kovacevic, B, Jacob, H, Partelli, S, Falconi, M, Salvia, R, Landoni, L, the ERASING study collaborators, Alfieri, S, Arcidiacono, PG, Arvanitakis, M, Battistella, A, Bernadroni, L, Brink, L, Cintolo, M, Conti Bellocchi, MC, Davì, MV, Deguelte, S, Deprez, P, Deviere, J, Ewald, J, Fabbri, C, Ferrari, G, Furnica, RM, Gabbrielli, A, Garcés-Duran, R, Giovannini, M, Gonda, T, Gornals, JB, Marx, M, Mazzola, M & Mutignani, M 2023, 'Endoscopic Ultrasound-guided Radiofrequency Ablation Versus Surgical Resection for Treatment of Pancreatic Insulinoma', Clinical Gastroenterology and Hepatology. https://doi.org/10.1016/j.cgh.2023.02.022

@article{95ed34ec50cc441cb1c467c240fae929,

title = "Endoscopic Ultrasound-guided Radiofrequency Ablation Versus Surgical Resection for Treatment of Pancreatic Insulinoma",

abstract = "BACKGROUND & AIMS: Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is emerging as a safe and effective treatment for pancreatic neuroendocrine tumors. We aimed to compare EUS-RFA and surgical resection for the treatment of pancreatic insulinoma (PI).METHODS: Patients with sporadic PI who underwent EUS-RFA at 23 centers or surgical resection at 8 high-volume pancreatic surgery institutions between 2014 and 2022 were retrospectively identified and outcomes compared using a propensity-matching analysis. Primary outcome was safety. Secondary outcomes were clinical efficacy, hospital stay, and recurrence rate after EUS-RFA.RESULTS: Using propensity score matching, 89 patients were allocated in each group (1:1), and were evenly distributed in terms of age, sex, Charlson comorbidity index, American Society of Anesthesiologists score, body mass index, distance between lesion and main pancreatic duct, lesion site, size, and grade. Adverse event (AE) rate was 18.0% and 61.8% after EUS-RFA and surgery, respectively (P < .001). No severe AEs were observed in the EUS-RFA group compared with 15.7% after surgery (P < .0001). Clinical efficacy was 100% after surgery and 95.5% after EUS-RFA (P = .160). However, the mean duration of follow-up time was shorter in the EUS-RFA group (median, 23 months; interquartile range, 14-31 months vs 37 months; interquartile range, 17.5-67 months in the surgical group; P < .0001). Hospital stay was significantly longer in the surgical group (11.1 ± 9.7 vs 3.0 ± 2.5 days in the EUS-RFA group; P < .0001). Fifteen lesions (16.9%) recurred after EUS-RFA and underwent a successful repeat EUS-RFA (11 patients) or surgical resection (4 patients).CONCLUSION: EUS-RFA is safer than surgery and highly effective for the treatment of PI. If confirmed in a randomized study, EUS-RFA treatment can become first-line therapy for sporadic PI.",

keywords = "Acute pancreatitis, Hypoglycemia, Insulin, Neuroendocrine Tumor, Pancreatic Fistula",

author = "Crin{\`o}, {Stefano Francesco} and Bertrand Napoleon and Antonio Facciorusso and Sundeep Lakhtakia and Ivan Borbath and Fabrice Caillol and {Do-Cong Pham}, Khanh and Gianenrico Rizzatti and Edoardo Forti and Laurent Palazzo and Arthur Belle and Peter Vilmann and {van Laethem}, {Jean Luc} and Mehdi Mohamadnejad and Sebastien Godat and Pieter Hindryckx and Ariel Benson and Matteo Tacelli and {De Nucci}, Germana and Cecilia Binda and Bojan Kovacevic and Harold Jacob and Stefano Partelli and Massimo Falconi and Roberto Salvia and Luca Landoni and {the ERASING study collaborators} and Sergio Alfieri and Arcidiacono, {Paolo Giorgio} and Marianna Arvanitakis and Anna Battistella and Laura Bernadroni and Lene Brink and Marcello Cintolo and {Conti Bellocchi}, {Maria Cristina} and Dav{\`i}, {Maria Vittoria} and Sophie Deguelte and Pierre Deprez and Jaques Deviere and Jacques Ewald and Carlo Fabbri and Giovanni Ferrari and Furnica, {Raluca Maria} and Armando Gabbrielli and Rodrigo Garc{\'e}s-Duran and Marc Giovannini and Tamas Gonda and Gornals, {Joan B.} and Mariola Marx and Michele Mazzola and Massimiliano Mutignani",

note = "Publisher Copyright: {\textcopyright} 2023 AGA Institute",

year = "2023",

doi = "10.1016/j.cgh.2023.02.022",

language = "English",

journal = "Clinical Gastroenterology and Hepatology",

issn = "1542-3565",

publisher = "W.B./Saunders Co",

}

TY - JOUR

T1 - Endoscopic Ultrasound-guided Radiofrequency Ablation Versus Surgical Resection for Treatment of Pancreatic Insulinoma

AU - Crinò, Stefano Francesco

AU - Napoleon, Bertrand

AU - Facciorusso, Antonio

AU - Lakhtakia, Sundeep

AU - Borbath, Ivan

AU - Caillol, Fabrice

AU - Do-Cong Pham, Khanh

AU - Rizzatti, Gianenrico

AU - Forti, Edoardo

AU - Palazzo, Laurent

AU - Belle, Arthur

AU - Vilmann, Peter

AU - van Laethem, Jean Luc

AU - Mohamadnejad, Mehdi

AU - Godat, Sebastien

AU - Hindryckx, Pieter

AU - Benson, Ariel

AU - Tacelli, Matteo

AU - De Nucci, Germana

AU - Binda, Cecilia

AU - Kovacevic, Bojan

AU - Jacob, Harold

AU - Partelli, Stefano

AU - Falconi, Massimo

AU - Salvia, Roberto

AU - Landoni, Luca

AU - the ERASING study collaborators

AU - Alfieri, Sergio

AU - Arcidiacono, Paolo Giorgio

AU - Arvanitakis, Marianna

AU - Battistella, Anna

AU - Bernadroni, Laura

AU - Cintolo, Marcello

AU - Conti Bellocchi, Maria Cristina

AU - Davì, Maria Vittoria

AU - Deguelte, Sophie

AU - Deprez, Pierre

AU - Deviere, Jaques

AU - Ewald, Jacques

AU - Fabbri, Carlo

AU - Ferrari, Giovanni

AU - Furnica, Raluca Maria

AU - Gabbrielli, Armando

AU - Garcés-Duran, Rodrigo

AU - Giovannini, Marc

AU - Gonda, Tamas

AU - Gornals, Joan B.

AU - Marx, Mariola

AU - Mazzola, Michele

AU - Mutignani, Massimiliano

A2 - Brink, Lene

PY - 2023

Y1 - 2023

N2 - BACKGROUND & AIMS: Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is emerging as a safe and effective treatment for pancreatic neuroendocrine tumors. We aimed to compare EUS-RFA and surgical resection for the treatment of pancreatic insulinoma (PI).METHODS: Patients with sporadic PI who underwent EUS-RFA at 23 centers or surgical resection at 8 high-volume pancreatic surgery institutions between 2014 and 2022 were retrospectively identified and outcomes compared using a propensity-matching analysis. Primary outcome was safety. Secondary outcomes were clinical efficacy, hospital stay, and recurrence rate after EUS-RFA.RESULTS: Using propensity score matching, 89 patients were allocated in each group (1:1), and were evenly distributed in terms of age, sex, Charlson comorbidity index, American Society of Anesthesiologists score, body mass index, distance between lesion and main pancreatic duct, lesion site, size, and grade. Adverse event (AE) rate was 18.0% and 61.8% after EUS-RFA and surgery, respectively (P < .001). No severe AEs were observed in the EUS-RFA group compared with 15.7% after surgery (P < .0001). Clinical efficacy was 100% after surgery and 95.5% after EUS-RFA (P = .160). However, the mean duration of follow-up time was shorter in the EUS-RFA group (median, 23 months; interquartile range, 14-31 months vs 37 months; interquartile range, 17.5-67 months in the surgical group; P < .0001). Hospital stay was significantly longer in the surgical group (11.1 ± 9.7 vs 3.0 ± 2.5 days in the EUS-RFA group; P < .0001). Fifteen lesions (16.9%) recurred after EUS-RFA and underwent a successful repeat EUS-RFA (11 patients) or surgical resection (4 patients).CONCLUSION: EUS-RFA is safer than surgery and highly effective for the treatment of PI. If confirmed in a randomized study, EUS-RFA treatment can become first-line therapy for sporadic PI.

AB - BACKGROUND & AIMS: Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is emerging as a safe and effective treatment for pancreatic neuroendocrine tumors. We aimed to compare EUS-RFA and surgical resection for the treatment of pancreatic insulinoma (PI).METHODS: Patients with sporadic PI who underwent EUS-RFA at 23 centers or surgical resection at 8 high-volume pancreatic surgery institutions between 2014 and 2022 were retrospectively identified and outcomes compared using a propensity-matching analysis. Primary outcome was safety. Secondary outcomes were clinical efficacy, hospital stay, and recurrence rate after EUS-RFA.RESULTS: Using propensity score matching, 89 patients were allocated in each group (1:1), and were evenly distributed in terms of age, sex, Charlson comorbidity index, American Society of Anesthesiologists score, body mass index, distance between lesion and main pancreatic duct, lesion site, size, and grade. Adverse event (AE) rate was 18.0% and 61.8% after EUS-RFA and surgery, respectively (P < .001). No severe AEs were observed in the EUS-RFA group compared with 15.7% after surgery (P < .0001). Clinical efficacy was 100% after surgery and 95.5% after EUS-RFA (P = .160). However, the mean duration of follow-up time was shorter in the EUS-RFA group (median, 23 months; interquartile range, 14-31 months vs 37 months; interquartile range, 17.5-67 months in the surgical group; P < .0001). Hospital stay was significantly longer in the surgical group (11.1 ± 9.7 vs 3.0 ± 2.5 days in the EUS-RFA group; P < .0001). Fifteen lesions (16.9%) recurred after EUS-RFA and underwent a successful repeat EUS-RFA (11 patients) or surgical resection (4 patients).CONCLUSION: EUS-RFA is safer than surgery and highly effective for the treatment of PI. If confirmed in a randomized study, EUS-RFA treatment can become first-line therapy for sporadic PI.

KW - Acute pancreatitis

KW - Hypoglycemia

KW - Insulin

KW - Neuroendocrine Tumor

KW - Pancreatic Fistula

UR - http://www.scopus.com/inward/record.url?scp=85151518633&partnerID=8YFLogxK

U2 - 10.1016/j.cgh.2023.02.022

DO - 10.1016/j.cgh.2023.02.022

M3 - Journal article

C2 - 36871765

AN - SCOPUS:85151518633

JO - Clinical Gastroenterology and Hepatology

JF - Clinical Gastroenterology and Hepatology

SN - 1542-3565

ER -

Endoscopic Ultrasound-guided Radiofrequency Ablation Versus Surgical Resection for Treatment of Pancreatic Insulinoma

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