Endoscopic ultrasound-guided radiofrequency ablation is a safe and efficient treatment of symptomatic insulinomas - a single center experience of 14 patients

Mikkel Andreassen; Bojan Kovacevic; Lene Brink; Hansen Carsten Palnaes; Ulrich Knigge; Peter Vilmann

doi:10.1530/endoabs.110.P891

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Endocrine Abstracts (2025) 110 P891 | DOI: 10.1530/endoabs.110.P891

ECEESPE2025 Poster Presentations Pituitary, Neuroendocrinology and Puberty (162 abstracts)

Endoscopic ultrasound-guided radiofrequency ablation is a safe and efficient treatment of symptomatic insulinomas – a single center experience of 14 patients

Mikkel Andreassen ¹ , Bojan Kovacevic ² , Lene Brink ² , Carsten Palnæs Hansen ³ , Ulrich Knigge ³ & Peter Vilmann ²

Author affiliations

¹Rigshospitalet, university of Copenhagen, Department of nephrology and endocrinology, Copenhagen, Denmark; ²Herlev Hospital, University of Copenhagen, Department of surgery, Copenhagen, Denmark; ³Rigshospitalet, University of Copenhagen, Department of Surgery, Copenhagen, Denmark

JOINT1267

Content: Insulinoma is the most common functional pancreatic neuroendocrine neoplasm. The vast majority are benign and less than 20 mm. Pancreatic surgery is considered standard treatment, but complications related to the surgical procedure are significant. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) represents a novel and minimally invasive approach.

Aim: To evaluate efficacy of EUS-RFA in localized insulinomas.

Methods: We prospectively included patients diagnosed with insulinoma based on symptomatic hypoglycemia with inappropriate high levels of insulin. Lesions considered for RFA treatment were localized biopsy proven pNEN (Ki-67<10%), size < 25 mm. The procedures were performed under general anesthesia. The patients were admitted for 24-hour observation after EUS-RFA. 3-6 months following EUS-RFA, efficacy was evaluated with EUS and 72-hours fasting test. 1 year after EUS-RFA, patients were re-evaluated for symptoms of hypoglycemia. In case of incomplete response, patients were eligible for a 2^nd treatment.

Results: From 2022 to 2024, all 14 patients referred to our department with insulinoma underwent EUS-RFA. Mean age 60 (range 31–79) years. The average size was 15.4 (range 9.0–23.0) mm, 5 were in the head of pancreas, 7 in neck/body and 2 in the tail. No adverse events were observed during the procedure and all patients were discharged after uneventful hospitalization. One patient presented with acute necrotizing pancreatitis 13 days after the procedure and underwent EUS-guided drainage. Normoglycemia was observed in 13 out of 14 patients 1-6 months after EUS-RFA and in 6 out of 7 patients 1 year after EUS-RFA. In 3 patients a 2^nd EUS-RFA procedure was needed, with complete remission in 2 patients and persistent hypoglycemia in the last patient.

Conclusion: EUS-RFA is an effective, minimally invasive treatment for localized insulinomas. The procedure seems to have a superior safety profile compared to conventional surgery, but long-term efficacy of EUS-RFA has yet to be evaluated.