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
12 Citations (Scopus)


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 languageEnglish
JournalClinical Gastroenterology and Hepatology
Publication statusAccepted/In press - 2023


  • Acute pancreatitis
  • Hypoglycemia
  • Insulin
  • Neuroendocrine Tumor
  • Pancreatic Fistula


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