EUS-RFA eases symptoms in patients with insulinomas

Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) offers a minimally invasive resolution of symptoms in patients with a suspicion of insulinomas and has a favourable safety profile relative to surgery, according to a study. However, its long-term efficacy warrants further investigation.

The authors retrospectively identified 17 patients (mean age 60.1 years, 53 percent male) suspected of insulinomas (based on a positive fasting test and imaging) who underwent EUS-RFA at a single tertiary care centre between 2022 and 2025. Lesions considered for RFA were biopsy-proven pancreatic neuroendocrine neoplasms (pNENs) with a Ki-67 index <10 percent and <25 mm in size.

All patients were hospitalized for 24 h. EUS-RFA was performed under general anaesthesia using a dedicated needle and under direct ultrasound guidance. The primary outcome was clinical success, defined as symptom improvement with a documented increase in blood glucose, and safety.

Over a mean follow-up duration of 15.5 months, 11 patients (64.7 percent) achieved normoglycaemia after a single EUS-RFA, while six (35.3 percent) required a second EUS-RFA. Overall, the clinical success rate was 100 percent (n=17/17; 95 percent confidence interval, 80.4‒100.0).

Four adverse events (AEs) occurred in 23 procedures (17.4 percent), as well as two mild and two moderate (8.7 percent) AEs.

“Insulinomas, although rare, are among the most common functional pNENs, causing debilitating and recurrent hypoglycaemic episodes and severely affecting quality of life,” the authors said.