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.

PATIENTS: We retrospectively identified patients at a single tertiary care center between 2022 and 2025 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 Ki-67 index <10%, and <25 mm in size. 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. Mean follow-up duration was 15.5 months. The primary outcome measure was clinical success (symptom improvement with a documented increase in blood glucose) and safety.

RESULTS

A total of 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%). A total of 4 adverse events were observed in 23 procedures (17.4%), 2 mild and 2 moderate (8.7%).

CONCLUSION

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.