Case Report Published on 14 Mar, 2024

Endoscopic Ultrasound-Guided Radiofrequency Ablation as Therapeutic Approach for Pancreatic Insulinoma

EUS-Guided RFA for Pancreatic Insulinoma
Vol. 19 No. 1 : 2024 (300-306)

Darshini S Darshini S
Khairul Najmi MN Khairul Najmi MN
Kok WH Kok WH
LEE CC LEE CC
Woo WH Woo WH
Wong Z Wong Z

Abstract
Insulinoma is one of the most prevalent form of functional neuroendocrine tumor of the pancreas (PNET) that often manifests with debilitating symptomatic hypoglycemia. When conventional imaging fails to detect the lesion, endoscopic ultrasound (EUS) have proven to be of value to determine the preoperative localisation as well as with biochemical sampling via fine needle aspiration of the suspected lesion. Surgical resection has been the standard care for these pancreatic neuroendocrine tumors. However, with recent advancements, endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) has emerged as a promising and less invasive therapeutic approach that carries a favourable outcome and a low risk of complications. We report eda patient with symptomatic pancreatic insulinoma who was treated with EUS-RFA.
Keywords : Endoscopic unltrasound, pancreatic insulinoma, radiofrequency ablation,
Abstrak
Insulinoma merupakan salah satu jenis tumor neuroendokrin fungsi pankreas (PNET) yang paling lazim dan sering ditunjukkan dengan hipoglisemia simptomatik yang memburukkan keadaan pesakit. Apabila imej konvensional gagal untuk mengesan lesi, ultrabunyi endoskopik (EUS) telah terbukti berguna dalam menentukan penempatan praoperasi serta dengan pengambilan sampel biokimia melalui aspirasi jarum halus terhadap lesi yang disyaki. Reseksi pembedahan telah menjadi rawatan piawai bagi tumor neuroendokrin pankreas ini. Walau bagaimanapun, dengan kemajuan terkini, ablasi radiofrekuensi panduan ultrabunyi endoskopik (EUS-RFA) telah muncul sebagai pendekatan terapeutik yang menjanjikan dan kurang invasif dengan hasil yang baik dan komplikasi yang rendah. Kami melaporkan seorang pesakit dengan insulinoma pankreas bersimptomatik yang dirawat dengan EUS-RFA.
Kata Kunci : Ablasi radiofrekuensi, insulinoma pankreas, ultrabunyi endoskopik,

Correspondance Address
Khairul Najmi Muhammad Nawawi. Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur Malaysia. Tel: +6018-3734807 Email: khairulnajmi84@gmail.com

References
Barthet, M., Giovannini, M., Lesavre, N., Boustiere, C., Napoleon, B., Koch, S., Gasmi, M., Vanbiervliet, G., Gonzalez, J.M. 2019. Endoscopic ultrasound-guided radiofrequency ablation for pancreatic neuroendocrine tumors and pancreatic cystic neoplasms: A prospective multicenter study. Endoscopy 51(9): 836-42.

Chaudhary, S., Sun, S.Y. 2017. Endoscopic ultrasound-guided radiofrequency ablation in gastroenterology: New horizons in search. World J Gastroenterol 23(27): 4892-6.

Eloubeidi, M.A., Decker, G.A., Chandrasekhara, V., Chathadi, K.V., Early, D.S., Evans, J.A., Fanelli, R.D., Fisher, D.A., Foley, K., Hwang, J.H., Jue, T.L., Lightdale, J.R., Pasha, S.F., Saltzman, J.R., Sharaf, R., Shergill, A.K., Cash, B.D., DeWitt, J.M. 2016. The role of endoscopy in the evaluation and management of patients with solid pancreatic neoplasia. Gastrointest Endosc 83(1): 17-28.

El Sayed, G., Frim, L., Franklin, J., McCrudden, R., Gordon, C., Al-Shamma, S., Kiss, S., Hegyi, P., Erőss, B., Hegyi, P.J. 2021. Endoscopic ultrasound-guided ethanol and radiofrequency ablation of pancreatic insulinomas: A systematic literature review. Therap Adv Gastroenterol 14: 17562848211042171.

Gaidhane, M., Smith, I., Ellen, K., Gatesman, J., Habib, N., Foley, P., Moskaluk, C., Kahaleh, M. 2012. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) of the pancreas in a porcine model. Gastroenterol Res Pract 2012: 431451

Goldberg, S.N., Mallery, S., Gazelle, G.S., Brugge, W.R. 1999. EUS-guided radiofrequency ablation in the pancreas: results in a porcine model. Gastrointest Endosc 50(3): 392-401.

Jonica, E.R., Wagh, M.S. 2020. Endoscopic treatment of symptomatic insulinoma with a new EUS-guided radiofrequency ablation device. VideoGIE 5(10): 483-5.

Khashab, M.A., Yong, E., Lennon, A.M., Shin, E.J., Amateau, S., Hruban, R.H., Olino, K., Giday, S., Fishman, E.K., Wolfgang, C.L., Edil, B.H., Makary, M., Canto, M. I. 2011. EUS is still superior to multidetector computerized tomography for detection of pancreatic neuroendocrine tumors. Gastrointest Endosc 73(4): 691-6.

Lakhtakia, S., Ramchandani, M., Galasso, D., Gupta, R., Venugopal, S., Kalpala, R., Reddy, D.N. 2016. EUS-guided radiofrequency ablation for management of pancreatic insulinoma by using a novel needle electrode (with videos). Gastrointest Endosc 83(1): 234-9.

Limmer, S., Huppert, P.E., Juette, V., Lenhart, A., Welte, M., Wietholtz, H. 2009. Radiofrequency ablation of solitary pancreatic insulinoma in a patient with episodes of severe hypoglycemia. Eur J Gastroenterol Hepatol 21(9): 1097-101.

Okabayashi, T., Shima, Y., Sumiyoshi, T., Kozuki, A., Ito, S., Ogawa, Y., Kobayashi, M., Hanazaki, K. 2013. Diagnosis and management of insulinoma. World J Gastroenterol 19(6): 829-37.

Placzkowski, K.A., Vella, A., Thompson, G.B., Grant, C.S., Reading, C.C., Charboneau, J.W., Andrews, J.C., Lloyd, R.V., Service, F.J. 2009. Secular trends in the presentation and management of functioning insulinoma at the Mayo Clinic, 1987-2007. J Clin Endocrinol Metab 94(4): 1069-73.

Salazar, R., Wiedenmann, B., Rindi, G., Ruszniewski, P. 2012. ENETS 2011 consensus guidelines for the management of patients with digestive neuroendocrine tumors: An update. Neuroendocrinol 95(2): 71-3.

Svoboda, C., Pachofszky, T., Mitrovits, N., Stimakovits, J., Schleischitz, A., Püspök, A. 2021. Endoscopic Ultrasound-guided radiofrequency ablation for treatment of benign insulinoma. Endoscopy 53(S01): S234.

Zhuo, F., Anastasopoulou, C. 2022. Insulinoma. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK544299/ [8 March 2023]
Correspondance Address

Barthet, M., Giovannini, M., Lesavre, N., Boustiere, C., Napoleon, B., Koch, S., Gasmi, M., Vanbiervliet, G., Gonzalez, J.M. 2019. Endoscopic ultrasound-guided radiofrequency ablation for pancreatic neuroendocrine tumors and pancreatic cystic neoplasms: A prospective multicenter study. Endoscopy 51(9): 836-42.

Chaudhary, S., Sun, S.Y. 2017. Endoscopic ultrasound-guided radiofrequency ablation in gastroenterology: New horizons in search. World J Gastroenterol 23(27): 4892-6.

Eloubeidi, M.A., Decker, G.A., Chandrasekhara, V., Chathadi, K.V., Early, D.S., Evans, J.A., Fanelli, R.D., Fisher, D.A., Foley, K., Hwang, J.H., Jue, T.L., Lightdale, J.R., Pasha, S.F., Saltzman, J.R., Sharaf, R., Shergill, A.K., Cash, B.D., DeWitt, J.M. 2016. The role of endoscopy in the evaluation and management of patients with solid pancreatic neoplasia. Gastrointest Endosc 83(1): 17-28.

El Sayed, G., Frim, L., Franklin, J., McCrudden, R., Gordon, C., Al-Shamma, S., Kiss, S., Hegyi, P., Erőss, B., Hegyi, P.J. 2021. Endoscopic ultrasound-guided ethanol and radiofrequency ablation of pancreatic insulinomas: A systematic literature review. Therap Adv Gastroenterol 14: 17562848211042171.

Gaidhane, M., Smith, I., Ellen, K., Gatesman, J., Habib, N., Foley, P., Moskaluk, C., Kahaleh, M. 2012. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) of the pancreas in a porcine model. Gastroenterol Res Pract 2012: 431451

Goldberg, S.N., Mallery, S., Gazelle, G.S., Brugge, W.R. 1999. EUS-guided radiofrequency ablation in the pancreas: results in a porcine model. Gastrointest Endosc 50(3): 392-401.

Jonica, E.R., Wagh, M.S. 2020. Endoscopic treatment of symptomatic insulinoma with a new EUS-guided radiofrequency ablation device. VideoGIE 5(10): 483-5.

Khashab, M.A., Yong, E., Lennon, A.M., Shin, E.J., Amateau, S., Hruban, R.H., Olino, K., Giday, S., Fishman, E.K., Wolfgang, C.L., Edil, B.H., Makary, M., Canto, M. I. 2011. EUS is still superior to multidetector computerized tomography for detection of pancreatic neuroendocrine tumors. Gastrointest Endosc 73(4): 691-6.

Lakhtakia, S., Ramchandani, M., Galasso, D., Gupta, R., Venugopal, S., Kalpala, R., Reddy, D.N. 2016. EUS-guided radiofrequency ablation for management of pancreatic insulinoma by using a novel needle electrode (with videos). Gastrointest Endosc 83(1): 234-9.

Limmer, S., Huppert, P.E., Juette, V., Lenhart, A., Welte, M., Wietholtz, H. 2009. Radiofrequency ablation of solitary pancreatic insulinoma in a patient with episodes of severe hypoglycemia. Eur J Gastroenterol Hepatol 21(9): 1097-101.

Okabayashi, T., Shima, Y., Sumiyoshi, T., Kozuki, A., Ito, S., Ogawa, Y., Kobayashi, M., Hanazaki, K. 2013. Diagnosis and management of insulinoma. World J Gastroenterol 19(6): 829-37.

Placzkowski, K.A., Vella, A., Thompson, G.B., Grant, C.S., Reading, C.C., Charboneau, J.W., Andrews, J.C., Lloyd, R.V., Service, F.J. 2009. Secular trends in the presentation and management of functioning insulinoma at the Mayo Clinic, 1987-2007. J Clin Endocrinol Metab 94(4): 1069-73.

Salazar, R., Wiedenmann, B., Rindi, G., Ruszniewski, P. 2012. ENETS 2011 consensus guidelines for the management of patients with digestive neuroendocrine tumors: An update. Neuroendocrinol 95(2): 71-3.

Svoboda, C., Pachofszky, T., Mitrovits, N., Stimakovits, J., Schleischitz, A., Püspök, A. 2021. Endoscopic Ultrasound-guided radiofrequency ablation for treatment of benign insulinoma. Endoscopy 53(S01): S234.

Zhuo, F., Anastasopoulou, C. 2022. Insulinoma. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK544299/ [8 March 2023]



Barthet, M., Giovannini, M., Lesavre, N., Boustiere, C., Napoleon, B., Koch, S., Gasmi, M., Vanbiervliet, G., Gonzalez, J.M. 2019. Endoscopic ultrasound-guided radiofrequency ablation for pancreatic neuroendocrine tumors and pancreatic cystic neoplasms: A prospective multicenter study. Endoscopy 51(9): 836-42.

Chaudhary, S., Sun, S.Y. 2017. Endoscopic ultrasound-guided radiofrequency ablation in gastroenterology: New horizons in search. World J Gastroenterol 23(27): 4892-6.

Eloubeidi, M.A., Decker, G.A., Chandrasekhara, V., Chathadi, K.V., Early, D.S., Evans, J.A., Fanelli, R.D., Fisher, D.A., Foley, K., Hwang, J.H., Jue, T.L., Lightdale, J.R., Pasha, S.F., Saltzman, J.R., Sharaf, R., Shergill, A.K., Cash, B.D., DeWitt, J.M. 2016. The role of endoscopy in the evaluation and management of patients with solid pancreatic neoplasia. Gastrointest Endosc 83(1): 17-28.

El Sayed, G., Frim, L., Franklin, J., McCrudden, R., Gordon, C., Al-Shamma, S., Kiss, S., Hegyi, P., Erőss, B., Hegyi, P.J. 2021. Endoscopic ultrasound-guided ethanol and radiofrequency ablation of pancreatic insulinomas: A systematic literature review. Therap Adv Gastroenterol 14: 17562848211042171.

Gaidhane, M., Smith, I., Ellen, K., Gatesman, J., Habib, N., Foley, P., Moskaluk, C., Kahaleh, M. 2012. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) of the pancreas in a porcine model. Gastroenterol Res Pract 2012: 431451

Goldberg, S.N., Mallery, S., Gazelle, G.S., Brugge, W.R. 1999. EUS-guided radiofrequency ablation in the pancreas: results in a porcine model. Gastrointest Endosc 50(3): 392-401.

Jonica, E.R., Wagh, M.S. 2020. Endoscopic treatment of symptomatic insulinoma with a new EUS-guided radiofrequency ablation device. VideoGIE 5(10): 483-5.

Khashab, M.A., Yong, E., Lennon, A.M., Shin, E.J., Amateau, S., Hruban, R.H., Olino, K., Giday, S., Fishman, E.K., Wolfgang, C.L., Edil, B.H., Makary, M., Canto, M. I. 2011. EUS is still superior to multidetector computerized tomography for detection of pancreatic neuroendocrine tumors. Gastrointest Endosc 73(4): 691-6.

Lakhtakia, S., Ramchandani, M., Galasso, D., Gupta, R., Venugopal, S., Kalpala, R., Reddy, D.N. 2016. EUS-guided radiofrequency ablation for management of pancreatic insulinoma by using a novel needle electrode (with videos). Gastrointest Endosc 83(1): 234-9.

Limmer, S., Huppert, P.E., Juette, V., Lenhart, A., Welte, M., Wietholtz, H. 2009. Radiofrequency ablation of solitary pancreatic insulinoma in a patient with episodes of severe hypoglycemia. Eur J Gastroenterol Hepatol 21(9): 1097-101.

Okabayashi, T., Shima, Y., Sumiyoshi, T., Kozuki, A., Ito, S., Ogawa, Y., Kobayashi, M., Hanazaki, K. 2013. Diagnosis and management of insulinoma. World J Gastroenterol 19(6): 829-37.

Placzkowski, K.A., Vella, A., Thompson, G.B., Grant, C.S., Reading, C.C., Charboneau, J.W., Andrews, J.C., Lloyd, R.V., Service, F.J. 2009. Secular trends in the presentation and management of functioning insulinoma at the Mayo Clinic, 1987-2007. J Clin Endocrinol Metab 94(4): 1069-73.

Salazar, R., Wiedenmann, B., Rindi, G., Ruszniewski, P. 2012. ENETS 2011 consensus guidelines for the management of patients with digestive neuroendocrine tumors: An update. Neuroendocrinol 95(2): 71-3.

Svoboda, C., Pachofszky, T., Mitrovits, N., Stimakovits, J., Schleischitz, A., Püspök, A. 2021. Endoscopic Ultrasound-guided radiofrequency ablation for treatment of benign insulinoma. Endoscopy 53(S01): S234.

Zhuo, F., Anastasopoulou, C. 2022. Insulinoma. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK544299/ [8 March 2023]