Rossi Gemma, Petrone Maria Chiara, Capurso Gabriele, Partelli Stefano, Falconi Massimo, Arcidiacono Paolo Giorgio
Division of Pancreato-Biliary Endoscopy and Endosonography, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milano 20132, Italy.
Department of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milano 20132, Italy.
World J Clin Cases. 2022 Jul 6;10(19):6514-6519. doi: 10.12998/wjcc.v10.i19.6514.
Endoscopic ultrasound (EUS)-guided radiofrequency ablation (RFA) has recently been proposed as a local treatment for functional pancreatic neuroendocrine neoplasms in patients unfit for surgery, in order to obtain clinical syndrome regression. Data on the safety and long-term effectiveness of this approach are scarce, and EUS-RFA procedures are not standardized.
The present case series reports 3 elderly patients with a pancreatic insulinoma and comorbidities, locally treated by EUS-guided RFA with clinical success in terms of hypoglycemic symptoms. RFA procedures were performed during deep sedation, under EUS control with a 19 G needle, an electrode 5-mm in size at a power of 30 W and multiple RFA applications during the same session in order to treat the whole area of the lesions. Immediate relief of symptoms was evident in 2 patients after the first EUS-RFA, while in the third patient a second endoscopic treatment was needed. All 3 patients are symptom-free without need of medications after 24 mo of follow-up with imaging follow-up showing no disease recurrence. A single adverse event of intraprocedural bleeding occurred, which was successfully treated endoscopically.
EUS-RFA represents an effective and safe alternative to surgery for the treatment of insulinomas in elderly patients at high surgical risk. However, larger multicenter studies with longer follow-up are needed in order to better assess its safety and clinical success.
内镜超声（EUS）引导下的射频消融（RFA）最近被提议作为局部治疗不适合手术的功能性胰腺神经内分泌肿瘤的方法，以实现临床综合征的缓解。关于这种方法的安全性和长期有效性的数据很少，并且EUS-RFA操作尚未标准化。
本病例系列报告了3例患有胰腺胰岛素瘤并伴有合并症的老年患者，通过EUS引导下的RFA进行局部治疗，在低血糖症状方面取得了临床成功。RFA操作在深度镇静下进行，在EUS控制下使用19G针，电极大小为5mm，功率为30W，并在同一次手术中进行多次RFA应用，以治疗病变的整个区域。2例患者在首次EUS-RFA后症状立即明显缓解，而第3例患者需要进行第二次内镜治疗。所有3例患者在随访24个月后均无症状，无需药物治疗，影像学随访显示无疾病复发。发生了1例术中出血的不良事件，通过内镜成功治疗。
对于手术风险高的老年患者，EUS-RFA是治疗胰岛素瘤的一种有效且安全的替代手术的方法。然而，需要进行更大规模、随访时间更长的多中心研究，以更好地评估其安全性和临床成功率。
