Treatment of functioning insulinoma using endoscopic ultrasound-guided radiofrequency ablation

85-year-old patient who underwent endoscopic ultrasound (EUS)-guided radiofrequency ablation for a functioning pancreatic insulinoma and was previously treated with acenocoumarol due to a high thrombotic risk. Acenocoumarol was discontinued three days prior to the procedure and replaced with enoxaparin at 40 mg daily, with the basal anticoagulant therapy being restarted 24 hours after the procedure. Ten days later, the patient was diagnosed with an acute hematoma in the tail of the pancreas and gastric body, which led to clinical signs of hypotension and acute anemia, requiring the discontinuation of anticoagulation once again. Therefore, we believe that caution should be taken when managing anticoagulant therapy in patients undergoing endoscopic ultrasound (EUS)-guided radiofrequency ablation.