New Method
EUS-guided alcohol ablation of an insulinoma

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Background

Surgical resection is currently considered to be the criterion standard for treatment of insulinomas. Alternative treatments, despite medication with diazoxide, are lacking. EUS-guided ethanol ablation of endocrine tumors has not been reported before.

Intervention

A 78-year-old woman was referred with typical symptoms of an insulinoma. Diagnosis was confirmed by laboratory findings, EUS, and EUS-guided FNA. Because of severe complications during several hypoglycemic episodes, a poor general condition, and strict refusal of surgical resection, the decision was made to ablate the insulinoma by EUS-guided alcohol injection. A total of 8 mL 95% ethanol was injected into the tumor.

Results

The patient was discharged and exhibited no further hypoglycemic episodes, and her general condition improved rapidly. Based on clinical, morphologic, and biochemical criteria, we achieved a durable complete remission of the tumor.

Conclusions

EUS-guided ablation may become a minimally invasive alternative for patients with insulinomas in whom surgery is not feasible.

Section snippets

Materials and methods

Diagnostic evaluation for suspected insulinoma was performed with a radial echoendoscope (acoustic frequencies 5/7.5/10 MHz; Pentax Hitachi radial EG-3630UR; Pentax Co. and Hitachi Co., Tokyo, Japan). For FNA, as well as for ablation by alcohol injection, the linear-array echoendoscope (5/7.5 MHz; Pentax Hitachi longitudinal FG-34UX; Pentax Co. and Hitachi Co.) was used.

FNA was done as described by Fritscher-Ravens et al.6 Fourteen smears on glass slides were air-dried, subsequently processed

Results

We report on a 78-year-old woman (body mass index 26.3 kg/m2) who has had recurrent symptomatic episodes of hypoglycemia since September 2000. In June 2002, the patient was referred to our hospital after repeated episodes of unconsciousness at home. After glucose was administered intravenously, she recovered without neurologic defect. Relatives reported on 2 similar episodes per week for the previous several months.

Laboratory findings and the patient's history indicated the presence of an

Discussion

Insulinomas are rare and usually become symptomatic by recurrent episodes of hypoglycemia. Attempts of nonsurgical ablation of neuroendocrine and pancreatic tumors have been reported. Scott et al7 described the successful percutaneous palliative ablation of liver metastases of a malignant insulinoma. Goldberg et al8 performed a study on the feasibility and the safety of EUS-guided radiofrequency ablation in the porcine pancreas. Recently, Gan et al5 demonstrated the feasibility of ethanol

References (9)

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