EUS-Guided Radiofrequency Ablation as a Minimally Invasive Treatment for Insulinomas-A Single-Center Experience

Insulinomas, although rare, are among the most common functional pancreatic neuroendocrine neoplasms (pNENs), causing debilitating and recurrent hypoglycemic episodes and severely affecting quality of life.

To evaluate endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) as a novel and minimally invasive treatment for insulinomas.

We retrospectively identified patients at a single tertiary care center between 2022 and 2025 with a suspicion of insulinomas (based on a positive fasting test and imaging) who underwent EUS-RFA. Lesions considered for RFA were biopsy-proven pNENs with a Ki-67 index <10%, and <25 mm in size. All patients were hospitalized for 24 hours and EUS-RFA was conducted under general anesthesia using a dedicated EUS-RFA needle and under direct ultrasound guidance. Mean follow-up duration was 15.5 months. The primary outcome measure was clinical success (symptom improvement with a documented increase in blood glucose) and safety.

A total of 17 patients were identified and included. The mean age was 60.1 years and 53% were male. Normoglycemia was achieved after a single EUS-RFA session in 11 patients (64.7%), while 6 patients (35.3%) required a second EUS-RFA. The overall clinical success rate was 100% (n = 17/17; 95% CI: 80.4%-100.0%). A total of 4 adverse events were observed in 23 procedures (17.4%), 2 mild and 2 moderate (8.7%).

EUS-RFA appears to provide complete symptom resolution and demonstrates a favorable safety profile compared to conventional surgery. However, the long-term efficacy of EUS-RFA remains to be determined.