El Sayed Ghassan, Frim Levente, Franklin Jamie, McCrudden Raymond, Gordon Charles, Al-Shamma Safa, Kiss Szabolcs, Hegyi Péter, Erőss Bálint, Hegyi Péter Jenő
The Royal Bournemouth Hospital, University Hospital Dorset, Bournemouth, UK.
Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.
Therap Adv Gastroenterol. 2021 Nov 18;14:17562848211042171. doi: 10.1177/17562848211042171. eCollection 2021.
Insulinoma is the most common neuroendocrine neoplasm of the pancreas, characterised by hypoglycaemic symptoms. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) and ethanol ablation (EUS-EA) are novel methods for treating insulinoma.We aimed to perform a systematic review to assess the efficacy and safety of EUS-guided ablation techniques for pancreatic insulinomas.
We systematically searched for articles detailing EUS-guided ablations of insulinomas. We performed a qualitative analysis and summarised data on the efficacy and safety of EUS-RFA and EUS-EA techniques.
In total, we identified 35 case reports and case series describing 75 patients with insulinomas treatment with EUS-guided ablation. Twenty-seven patients were treated with EUS-RFA, 47 patients with EUS-EA, and 1 patient received EUS-EA and EUS-RFA in the same session. In total, 84 insulinomas were ablated (EUS-RFA: 31, EUS-EA: 53). Most insulinomas were in the head of the pancreas (40%). The clinical success rate for EUS-guided ablation techniques was 98.5%. The median glucose level was 1.95 (Q1-Q3: 1.69-2.13) mmol/L before ablation compared to 6.20 (Q1-Q3: 5.30-7.05) mmol/L after treatment. The median insulin and C-peptide levels before and after RFA/EA were 230 (Q1-Q2: 120-257) pmol/L and 41 (Q1-Q2 35-42) pmol/L; 2077 (Q1-Q2 1644-2459) pmol/L and 819 (Q1-Q2 696-1072) pmol/L, respectively. There were eleven adverse events: seven abdominal pain, two mild acute pancreatitis, one necrotising acute pancreatitis and one local hematoma. All patients recovered, and there were no periprocedural deaths.
EUS-guided ablation of insulinoma seems to be a safe and effective treatment and is an alternative to surgical resection in selected cases.
胰岛素瘤是胰腺最常见的神经内分泌肿瘤，以低血糖症状为特征。内镜超声引导下射频消融术（EUS-RFA）和乙醇消融术（EUS-EA）是治疗胰岛素瘤的新方法。我们旨在进行一项系统评价，以评估超声内镜引导下消融技术治疗胰腺胰岛素瘤的疗效和安全性。
我们系统检索了详细描述超声内镜引导下胰岛素瘤消融术的文章。我们进行了定性分析，并总结了EUS-RFA和EUS-EA技术的疗效和安全性数据。
我们共识别出35篇病例报告和病例系列，描述了75例接受超声内镜引导下消融术治疗的胰岛素瘤患者。27例患者接受了EUS-RFA治疗，47例患者接受了EUS-EA治疗，1例患者在同一次治疗中接受了EUS-EA和EUS-RFA治疗。总共消融了84个胰岛素瘤（EUS-RFA：31个，EUS-EA：53个）。大多数胰岛素瘤位于胰头（40%）。超声内镜引导下消融技术的临床成功率为98.5%。消融术前血糖中位数为1.95（四分位间距：1.69 - 2.13）mmol/L，治疗后为6.20（四分位间距：5.30 - 7.05）mmol/L。RFA/EA前后胰岛素和C肽水平中位数分别为230（四分位间距：120 - 257）pmol/L和41（四分位间距35 - 42）pmol/L；2077（四分位间距1644 - 2459）pmol/L和819（四分位间距696 - 1072）pmol/L。发生了11起不良事件：7例腹痛、2例轻度急性胰腺炎、1例坏死性急性胰腺炎和1例局部血肿。所有患者均康复，且围手术期无死亡病例。
超声内镜引导下胰岛素瘤消融术似乎是一种安全有效的治疗方法，在某些特定病例中可作为手术切除的替代方案。
