Division of Endocrinology and Nutrition, Cliniques Universitaires St Luc, Université catholique de Louvain, Avenue Hippocrate nr 10, 1200 Brussels, Belgium.
Division of Hepatogastroenterology, Cliniques Universitaires St Luc, Université catholique de Louvain, Brussels, Belgium.
Ann Endocrinol (Paris). 2020 Dec;81(6):567-571. doi: 10.1016/j.ando.2020.11.009. Epub 2020 Dec 5.
Insulinomas are usually benign, small-sized, well-encapsulated and often solitary pancreatic tumors. Currently, enucleation is the treatment of choice for sporadic solitary insulinoma if diameter is less than 2cm and the structural integrity of the pancreatic duct can be maintained. However, the procedure has a risk of postoperative complications, and especially of pancreatic fistula. There is growing interest in endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) as an effective and less invasive alternative treatment for benign sporadic insulinoma.
We retrospectively analyzed the efficacy and safety of EUS-RFA in four patients with benign localized insulinoma treated in our tertiary care center between June 2018 and November 2019. EUS-RFA was performed with a EUS-guided RFA 19-gauge needle electrode (Starmed; Taewoong Medical, Seoul, South Korea) that released energy at 50W up to 100 Ohms impedance.
The series comprised three women and one man, with a median age of 58 years (range 52-82 years). Mean tumor size was 12mm. Although three of the four patients would have been eligible for surgery, EUS-RFA was proposed to them. Symptomatic and biological improvement occurred immediately, generally straight after the procedure, in all patients, and no serious complications were observed. During the mean follow-up period of 22 months, no symptom recurrence was observed.
This preliminary report in 4 patients showed that EUS-RFA was an effective and relatively safe alternative treatment, devoid of major complications, for benign sporadic insulinoma. Larger-scale prospective multicenter studies are, however, needed to confirm the long-term effectiveness and safety of this novel technique.
胰岛素瘤通常为良性、体积小、有包膜且常为单发的胰腺肿瘤。目前，如果直径小于 2cm 且胰管结构完整，肿瘤可保持其完整性，则局部切除术是散发性单发胰岛素瘤的首选治疗方法。然而，该手术存在术后并发症的风险，尤其是胰瘘。内镜超声引导下射频消融术（EUS-RFA）作为治疗良性散发性胰岛素瘤的有效、微创替代治疗方法，越来越受到关注。
我们回顾性分析了 2018 年 6 月至 2019 年 11 月期间在我们的三级护理中心接受治疗的 4 例良性局限性胰岛素瘤患者的 EUS-RFA 疗效和安全性。采用 EUS 引导的 19 号射频消融针电极（Starmed；Taewoong Medical，首尔，韩国）进行 EUS-RFA，该针电极释放 50W 能量，阻抗可达 100 欧姆。
该系列研究包括 3 名女性和 1 名男性，中位年龄为 58 岁（范围 52-82 岁）。平均肿瘤大小为 12mm。虽然这 4 例患者中有 3 例符合手术标准，但向他们提出了 EUS-RFA 治疗建议。所有患者的症状和生物学改善均立即发生，通常在手术后即刻出现，且未观察到严重并发症。在平均 22 个月的随访期间，未观察到症状复发。
本研究初步报道了 4 例患者，表明 EUS-RFA 是一种有效且相对安全的替代治疗方法，无严重并发症，适用于良性散发性胰岛素瘤。然而，需要进行更大规模的前瞻性多中心研究来确认该新技术的长期疗效和安全性。
