728 SUSTAINED CLINICAL RESPONSE WITH EUS GUIDED RFA OF PANCREATIC INSULINOMA

Abstract

Insulinoma is the commonest functional Pancreatic Neuro-Endocrine Tumor (f-PNET). Surgical resection is the standard management, often associated with significant morbidity. Alternate less invasive management options with EUS guided local therapy (Radio-frequency ablation or alcohol injection) are reportedly effective in short term follow-up. To evaluate the long-term efficacy of EUS guided RFA (EUS-RFA) used for the ablation of f-PNET. EUS-RFA of f-PNET was performed using a dedicated internally cooled 19G device. Lesions located close (≤5mm) to the pancreatic duct (PD) underwent prophylactic PD stent. Patients with a persistent symptomatic lesion or those with multiple lesions were considered for subsequent session/s of EUS-RFA. All patients post RFA underwent systematic follow up (3 monthly in the first year, 6 monthly in next year and at 1-year interval thereafter). 10 Insulinoma patients with 13 lesions underwent EUS-RFA over 5 years. One patient had 4 lesions. The mean tumor size was 11.5 mm (range ?). Three patients had prophylactic PD stent. Eight subjects had one EUS-RFA session. Two patients required >1 session. All subjects had rapid relief of symptoms along with biochemical improvement (blood sugar, insulin, C-peptide) within 24 hours that has remained sustained over the next 10 – 64 months. Post-procedure, one subject had mild self-limiting abdominal pain. Another patient developed acute pancreatitis after 3rd session of EUS RFA leading to pseudocyst that required EUS drainage. Tumor size decreased in 10/14 lesions (undetectable in 6, significantly reduced in 4). Remaining 4 lesions are stable in size with reduced vascularity. EUS guided RFA is safe and effective with sustained beneficial outcomes for Pancreatic Insulinoma.