Case Report
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World J Gastrointest Endosc. Oct 16, 2014; 6(10): 506-509
Published online Oct 16, 2014. doi: 10.4253/wjge.v6.i10.506
Role of preoperative endoscopic ultrasound-guided fine-needle tattooing of a pancreatic head insulinoma
Pornchai Leelasinjaroen, Wuttiporn Manatsathit, Richard Berri, Mohammed Barawi, Frank G Gress
Pornchai Leelasinjaroen, Wuttiporn Manatsathit, Department of Medicine, St. John Hospital and Medical Center, Detroit, MI 48236, United States
Richard Berri, Department of Surgery, St. John Hospital and Medical Center, Detroit, MI 48236, United States
Mohammed Barawi, Division of Gastroenterology, Department of Medicine, St. John Hospital and Medical Center, Detroit, MI 48236, United States
Frank G Gress, Division of Digestive Diseases, Columbia University Medical Center, New York, NY 10032, United States
Author contributions: Leelasinjaroen P and Manatsathit W researched/reviewed the current literature and wrote the paper; Barawi M performed the endoscopic procedure, provided the endoscopic image and reviewed manuscript; Berri R performed surgery provided the intraoperative images and reviewed manuscript; Gress FG reviewed manuscript.
Correspondence to: Pornchai Leelasinjaroen, MD, Resident Physician, Department of Medicine, St. John Hospital and Medical Center, 22101 Moross Rd, Detroit, MI 48236, United States. tee_pornchai@yahoo.com
Telephone: +1-734-2723147 Fax: +1-313-3437271
Received: June 23, 2014
Revised: August 8, 2014
Accepted: September 4, 2014
Published online: October 16, 2014
Processing time: 117 Days and 5.7 Hours
Abstract

Although insulinomas are rare, they are the most common pancreatic neuroendocrine tumor, with an incidence of four cases per million population. Insulinomas are generally benign indolent intrapancreatic tumors. Surgical resection remains the main option for treatment. However, up to 67% of a pancreatic head insulinomas are nonpalpable, thus surgical resection of the nonplapable insulinoma in this area could become problematic resulting in prolonged surgical time, increased risk of pancreatic duct injury and need for pancreaticoduodenectomy. Endoscopic ultrasound-guided fine- needle tattooing (EUS-FNT), has been shown to have a crucial role for localization of pancreatic body and tail lesions, facilitating laparoscopic distal pancreatectomy and helping surgeons identify the location of the tumor. EUS-FNT might have a role for preoperative localization of pancreatic head insulinomas which are likely to be nonpalpable. We report a case of preoperative EUS-FNT for localization of a nonplapable pancreatic head insulinoma. This report demonstrates that EUS-FNT of pancreatic head insulinomas may facilitate surgical resection, reduce operative time and decrease surgical complications.

Keywords: Insulinoma; Endosonography; Endoscopic ultrasound-guided fine-needle tattooing; Pancreas; Neuroendocrine tumors

Core tip: Preoperative endoscopic ultrasound-guided fine- needle tattooing (EUS-FNT) pancreatic body and tail lesion has shown to decrease operative time and facilitate laparoscopic distal pancreatectomy. We reported that preoperative EUS-FNT can effectively help localizing non-palpable pancreatic head insulinoma, especially in deep pancreatic parenchymal tissue. EUS-FNT helps precisely localizing the tumor and avoiding pancreatic duct and vascular injury from surgery. Furthermore this technique may help in preserving normal pancreatic tissue, reducing operative time and most importantly minimizing risks of pancreaticoduodenectomy. EUS-FNT represents a safe and useful role for the preoperative localization and surgical planning of the pancreatic head insulinoma.