Abstract
BACKGROUND: Insulinomas are the most common functional pancreatic neuroendocrine tumors (pNETs). Minimally invasive approaches like endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) and ethanol ablation (EUS-EA) are emerging treatment options for small insulinomas (<2 cm). OBJECTIVES: To assess the safety, efficacy, and long-term outcomes of EUS-RFA and EUS-EA in treating small pancreatic insulinomas. DESIGN: A retrospective, single-center study of nine patients diagnosed with insulinomas and treated with EUS ablation methods. METHODS: Nine lesions (mean size 11 mm; range: 6-19 mm) were treated with EUS-RFA (n = 7) or EUS-EA (n = 2). EUS-RFA procedures had a mean ablation time of 31 s (range: 17-69 s), while EUS-EA used a mean ethanol volume of 1.4 ml and 0.5 ml for respective patients. All patients were followed up radiologically with CT and/or EUS for a median of 25 months (range: 6-46 months). RESULTS: All patients had immediate hypoglycemia relief after a single treatment. The median clinical follow-up was 40 months (range: 22-60 months), with all patients remaining asymptomatic. Complete radiologic regression was observed in six patients. Two patients had minor adverse events; no severe complications occurred. CONCLUSION: EUS-guided ablation (RFA or EA) is a safe and effective treatment for small pancreatic insulinomas, providing symptom relief and radiologic regression. Further studies are needed to evaluate long-term efficacy and recurrence rates.