ECE2017 Eposter Presentations: Adrenal and Neuroendocrine Tumours Endocrine tumours and neoplasia (50 abstracts)
Could alcohol ablation become the standard of care for benign insulinomas?
Isabel Mazarico 1 , David Subías 1 , Fèlix Junquera 2 , Carme Vilardell 3 , Ignasi Saigí 4 , Albert Cano 1 , Laia Casamitjana 1 , Olga Giménez-Palop 1 , Lara Albert 1 , Ismael Capel 1 , Assumpta Caixàs 1 & Mercedes Rigla 1
1Endocrinology and Nutrition Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain; 2Department of Gastroenterology, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain; 3Endocrinology and Nutrition Department, Althaia Fundation, Manresa, Spain; 4Internal Medicine Department, Consorci Hospitalari de Vic, Vic, Spain.
Introduction: Surgical resection is currently considered the standard treatment for symptomatic insulinomas; however, its morbidity is high (>10%) and it is restricted to suitable candidates. In recent years, alternative minimally invasive therapies, such as endoscopic ultrasound (EUS)-guided ethanol ablation (EA), have emerged as new therapeutic options, especially for small lesions or poor surgical candidates. We report two cases of insulinoma ablated with EA.
Cases report: We report two cases of recurrent hypoglycaemia due to benign insulinoma: a 75-year- old man, with a 9 mm hypoechoic lesion in the neck of the pancreas, unfit for surgery because of comorbidities (case 1); and a 71-year- old man with a 19×14 mm hypoechoic lesion in the pancreas head, who refused surgery treatment (case 2). EUS fine needle aspiration (EUS-FNA) confirmed neuroendocrine tumor with a Ki67 <5% in both of them. They were admitted to our department for EA. Insulinomas were punctured under EUS guidance with a 22 G needle. A total volume of 0.8 ml (case 1) and 13 ml (case 2) ethanol 98% was injected. After each injection a whitish halo was observed inside the lesion, and no extravasation of alcohol was detected. There were no perioperative or postoperative complications. In case 1, hypoglycaemia was not reported along the two years follow-up period. Case 2 presented occasional mild hypoglycaemia 1 year after treatment, so we considered repeating EA, but the patient refused it.
Conclusion: EUS-guided ethanol ablation of a single small insulinoma is an effective, minimally invasive, and safe therapeutic modality. Currently, it is considered when surgery cannot be an option. However, this new technique should be applied to a wider range of potential candidates. A multicentric study seems necessary to establish the indications of EA in insulinomas.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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