Endoscopic ultrasound-guided radiofrequency ablation of pancreatic insulinoma.

BACKGROUND

Insulinoma is a rare pancreatic neuroendocrine tumor (pNET) arising from beta cells, leading to excessive insulin secretion and life-threatening hypoglycemia. While surgical resection remains the gold standard, endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) has emerged as a minimally invasive alternative, particularly for patients unfit for surgery.

AIMS: A meta-analysis was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines to compare the efficacy and safety of EUS-RFA and surgery for pancreatic insulinomas.

METHODS

Systematic searches were conducted in PubMed, Cochrane Library, Embase, and Scopus, using MeSH terms related to insulinoma, RFA, and surgery. Eligible studies included cohort studies and case series reporting clinical outcomes, adverse events, recurrence rates, and hospitalization. Statistical analyses were performed with Comprehensive Meta-analysis Software and RevMan 5.

RESULTS

A total of 20 studies were included, comprising 142 patients treated with EUS-RFA and 249 with surgery. Clinical success was higher in the EUS-RFA group (97.5%) compared with surgery (88.9%). Patients undergoing EUS-RFA experienced fewer complications (23 vs. 59%), shorter hospital stays (mean 2.4 vs. 11 days), and zero procedure-related mortality. However, recurrence rates were greater with EUS-RFA (11%) than with surgery (4.8%). No significant differences were found in overall survival during follow-up.

CONCLUSIONS

EUS-RFA is a safe, effective, and less invasive option for managing pancreatic insulinomas, ensuring rapid recovery and fewer complications. Nevertheless, its higher recurrence rate highlights the importance of patient selection and strict follow-up. Surgery remains the treatment of choice in resectable cases, while EUS-RFA represents a valuable alternative in high-risk or inoperable patients.