Endoscopic Ultrasound-Guided Ethanol Ablation for Benign Insulinoma: A Single-Centre Experience and Literature Review

Insulinoma is a predominantly benign pancreatic neuroendocrine tumour that is traditionally managed surgically. However, surgical invasiveness and anaesthesia-related risks limit its applicability in selected patients. Endoscopic ultrasound (EUS)-guided ethanol ablation has emerged as a minimally invasive alternative. This study aimed to evaluate the efficacy, safety, and feasibility of EUS-guided ethanol ablation for benign insulinoma.

We retrospectively analysed 17 patients with insulinoma who underwent EUS-guided ethanol ablation, predominantly as a primary treatment. All procedures were performed by experienced gastroenterologists using 95% absolute ethanol.

The study cohort had a mean age of 58.47 ± 12.29 years and a mean disease duration of 34.43 months (range, 0.36-84.0). Clinical success was achieved in 16 patients (94.1%). One patient with an initial suboptimal response successfully underwent a repeat ablation after 8 months. Over a median follow-up period of 46.1 months (range, 6.6-97.8), one patient was lost to follow-up. Disease recurrence was observed in four patients, resulting in a recurrence rate of 25% (4/16) among those with available follow-up data. Three recurrent cases underwent repeat ablation, all achieving symptomatic resolution. A total of 22 ablation procedures were performed. Adverse events were documented in 36.4% (8/22) of procedures, with the majority being mild (31.8%, 7/22) and one severe adverse event (4.5%, 1/22).

EUS-guided ethanol ablation is an effective and well-tolerated treatment for benign insulinoma. It represents a viable minimally invasive alternative to surgery and remains effective for managing recurrence or initial treatment failure without compromising subsequent surgical options.