Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 6, 2022; 10(19): 6514-6519
Published online Jul 6, 2022. doi: 10.12998/wjcc.v10.i19.6514
Endoscopic ultrasound radiofrequency ablation of pancreatic insulinoma in elderly patients: Three case reports
Gemma Rossi, Maria Chiara Petrone, Gabriele Capurso, Stefano Partelli, Massimo Falconi, Paolo Giorgio Arcidiacono
Gemma Rossi, Maria Chiara Petrone, Gabriele Capurso, Paolo Giorgio Arcidiacono, Division of Pancreato-Biliary Endoscopy and Endosonography, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milano 20132, Italy
Stefano Partelli, Massimo Falconi, Department of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milano 20132, Italy
Author contributions: Rossi G, Petrone MC, Capurso G, Arcidiacono PG made substantial contributions to conception and design of the study, acquisition of data, or analysis and interpretation of data; Rossi G, Petrone MC, Capurso G, Partelli S, Falconi M, Arcidiacono PG drafted the article or made critical revisions related to important intellectual content of the manuscript; and all authors provided final approval of the version of the article to be published.
Informed consent statement: All three patients included in the present case series gave their consent prior to study inclusion.
Conflict-of-interest statement: The authors have note conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gabriele Capurso, MD, PhD, Chief Doctor, Division of Pancreato-Biliary Endoscopy and Endosonography, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Via Olgettina 60, Milano 20132, Italy. capurso.gabriele@hsr.it
Received: August 12, 2021
Peer-review started: August 12, 2021
First decision: October 3, 2021
Revised: October 16, 2021
Accepted: May 14, 2022
Article in press: May 14, 2022
Published online: July 6, 2022
Abstract
BACKGROUND

Endoscopic ultrasound (EUS)-guided radiofrequency ablation (RFA) has recently been proposed as a local treatment for functional pancreatic neuroendocrine neoplasms in patients unfit for surgery, in order to obtain clinical syndrome regression. Data on the safety and long-term effectiveness of this approach are scarce, and EUS-RFA procedures are not standardized.

CASE SUMMARY

The present case series reports 3 elderly patients with a pancreatic insulinoma and comorbidities, locally treated by EUS-guided RFA with clinical success in terms of hypoglycemic symptoms. RFA procedures were performed during deep sedation, under EUS control with a 19 G needle, an electrode 5-mm in size at a power of 30 W and multiple RFA applications during the same session in order to treat the whole area of the lesions. Immediate relief of symptoms was evident in 2 patients after the first EUS-RFA, while in the third patient a second endoscopic treatment was needed. All 3 patients are symptom-free without need of medications after 24 mo of follow-up with imaging follow-up showing no disease recurrence. A single adverse event of intraprocedural bleeding occurred, which was successfully treated endoscopically.

CONCLUSION

EUS-RFA represents an effective and safe alternative to surgery for the treatment of insulinomas in elderly patients at high surgical risk. However, larger multicenter studies with longer follow-up are needed in order to better assess its safety and clinical success.

Keywords: Endoscopic ultrasound, Radiofrequency ablation, Insulinomas, Neuroendocrine neoplasms, Ablative therapies, Case report

Core Tip: Endoscopic ultrasound (EUS)-guided radiofrequency ablation (RFA) has been proposed as a local treatment for functional pancreatic neuroendocrine neoplasms in patients unfit for surgery. However, data on safety and long-term effectiveness are scarce and procedures are not standardized. The present case series reports 3 elderly patients with comorbidities diagnosed with a pancreatic insulinoma who received local treatment by EUS-guided RFA with a standardized protocol, with clinical success in terms of hypoglycemic symptoms over a relatively long follow-up. Effective EUS-RFA represents an alternative to surgery for the treatment of insulinoma in elderly patients at high surgical risk. However, larger multicenter studies with longer follow-up are needed in order to assess the safety and clinical success of this treatment.