Dąbkowski Krzysztof, Gajewska Paula, Walter Kamila, Londzin-Olesik Magdalena, Białek Andrzej, Andrysiak-Mammos Elżbieta, Kos-Kudła Beata, Starzyńska Teresa
Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland, Poland.
Endokrynol Pol. 2017;68(4):472-479. doi: 10.5603/EP.2017.0053.
EUS-guided ethanol ablation of insulinoma is a new method of treatment of this neuroendocrine tumour. Ablation is recommended in patients who are poor surgical candidates or refuse surgery. We present a case of an 81-year-old female with symptomatic insulinoma, treated successfully with EUS-guided alcoholic ablation, along with a literature review including 28 other previously described cases. The effectiveness, safety of the therapy, and technical procedure-related issues are summarised. To the best of our knowledge, this is the first described case of successful insulinoma EUS-guided ablation in Poland.
We searched the PubMed/Medline database to identify cases of EUS-guided alcoholic ablation. Our analysis included 14 articles (case reports or case series), with a total of 27 patients and 31 tumours described, published before February 2017.
The described tumours were relatively small (mean 13 mm), and the most common location was pancreatic head. The mean ethanol volume injected to the tumour was 1.8 ml and the concentration of infused alcohol varied from 95% to 98%.Side effects were observed in six cases; apart from one, they were mild and self-limiting. There was only one severe adverse event, treated conservatively with success. The median follow-up was 14.4 months (2-55 months). In all described cases ablation led to improvement of the symptoms and normalisation of glycaemia.
The EUS-guided alcoholic ablation of insulinoma is a safe and effective method of treatment in patients who are poor surgical candidates and/or refuse surgery. The adverse effects are rare and mild and were observed when the volume of injected ethanol was equal to or above 3.0 ml. However, the data is limited, the follow-up is relatively short, and prospective studies are needed to confirm the long-term effects of treatment. The study shows also that there are important procedural differences (concentration and volume of alcohol, needle gauge, number of sessions) between the endoscopists, which should be specified.
超声内镜引导下乙醇消融胰岛素瘤是治疗这种神经内分泌肿瘤的一种新方法。对于手术风险高或拒绝手术的患者，推荐采用消融治疗。我们报告一例81岁有症状的胰岛素瘤女性患者，成功接受了超声内镜引导下乙醇消融治疗，并对包括其他28例先前报道病例的文献进行了综述。总结了该治疗方法的有效性、安全性及与技术操作相关的问题。据我们所知，这是波兰首例成功进行超声内镜引导下胰岛素瘤消融的病例。
我们检索了PubMed/Medline数据库以确定超声内镜引导下乙醇消融的病例。我们的分析纳入了14篇文章（病例报告或病例系列），共描述了27例患者和31个肿瘤，这些文章发表于2017年2月之前。
所描述的肿瘤相对较小（平均13毫米），最常见的位置是胰头。注入肿瘤的乙醇平均体积为1.8毫升，注入酒精的浓度在95%至98%之间。6例出现了副作用；除1例之外，其余均为轻度且可自行缓解。仅发生1例严重不良事件，经保守治疗成功。中位随访时间为14.4个月（2至55个月）。在所有报道的病例中，消融均使症状改善且血糖恢复正常。
超声内镜引导下乙醇消融胰岛素瘤对于手术风险高和/或拒绝手术的患者是一种安全有效的治疗方法。不良反应罕见且轻微，当注入乙醇体积等于或超过3.0毫升时会出现。然而，数据有限，随访时间相对较短，需要进行前瞻性研究以证实治疗的长期效果。该研究还表明，内镜医师之间在操作程序上存在重要差异（酒精浓度和体积、针的规格、治疗次数），应予以明确。
