Endoscopic ultrasound-guided radiofrequency ablation for a pancreatic insulinoma: a novel endoscopic management strategy
Year: 2025
Type: article
Study design: Case Report
Abstract: Although rare, insulinomas are the most common functional pancreatic neuroendocrine tumors (NETs), typically presenting with Whipple’s triad – symptoms of hypoglycemia, low plasma glucose, and symptom resolution after glucose administration [ 1 ]. While surgery remains the primary curative treatment for an insulinoma, its potential for significant adverse outcomes has prompted exploration of less invasive approaches, such as endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) [ 2 ] [ 3 ]. EUS-RFA has shown high efficacy and a favorable safety profile in the treatment of insulinomas, especially for patients who are not suitable for surgery [ 4 ]. The purpose of presenting this case is to highlight the role of EUS-RFA as a minimally invasive and effective treatment option for an insulinoma in a patient who declined to undergo surgery ([ Video 1 ]). Download Endoscopic ultrasound-guided radiofrequency ablation is performed to treat an insulinoma in the pancreatic head.Video 1 A 37-year-old man with Crohn’s disease presented with recurrent fasting hypoglycemia and met Whipple’s triad. Laboratory testing showed endogenous hyperinsulinemia. Computed tomography and positron emission tomography (PET) 68 GA-dotatate scans were negative. EUS revealed a 13-mm well-differentiated NET in the pancreatic head, with additional subcentimeter lesions, and fine-needle biopsy confirmed this was an insulinoma ([ Fig. 1 ]). Surgical enucleation was deemed high risk owing to proximity to the main pancreatic duct and the risk of fistula formation, and the patient declined to undergo a Whipple surgery. After multidisciplinary review, EUS-RFA was selected as the treatment modality. The procedure was technically successful without complications, with complete resolution of the patient’s symptoms and improvement of his biochemical parameters. Fig. 1 Endoscopic ultrasound (EUS) image showing: a the insulinoma in the pancreatic head; b EUS-guided fine-needle biopsy being performed. This case highlights EUS-RFA as an effective minimally invasive option for insulinomas in select patients who are not ideal surgical candidates or who elect not to undergo surgery. Further prospective trials are needed to validate the long-term efficacy of EUS-RFA and better characterize its safety profile, including the incidence and management of potential adverse events. Endoscopy_UCTN_Code_TTT_1AS_2AI Endoscopy E-Videos https://eref.thieme.de/e-videos E-Videos is an open access online section of the journal Endoscopy , reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/ ). This section has its own submission website at https://mc.manuscriptcentral.com/e-videos . Publication History Article published online: 09 October 2025 © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/). Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
Source: Endoscopy
DOI: 10.1055/a-2712-3773
Institutions: University of Minnesota, University of Minnesota System
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4415004929