EUS-guided alcohol ablation of an insulinoma.
BACKGROUND
Surgical resection is currently considered to be the criterion standard for treatment of insulinomas. Alternative treatments, despite medication with diazoxide, are lacking. EUS-guided ethanol ablation of endocrine tumors has not been reported before.


METHODS
A 78-year-old woman was referred with typical symptoms of an insulinoma. Diagnosis was confirmed by laboratory findings, EUS, and EUS-guided FNA. Because of severe complications during several hypoglycemic episodes, a poor general condition, and strict refusal of surgical resection, the decision was made to ablate the insulinoma by EUS-guided alcohol injection. A total of 8 mL 95% ethanol was injected into the tumor.


RESULTS
The patient was discharged and exhibited no further hypoglycemic episodes, and her general condition improved rapidly. Based on clinical, morphologic, and biochemical criteria, we achieved a durable complete remission of the tumor.


CONCLUSIONS
EUS-guided ablation may become a minimally invasive alternative for patients with insulinomas in whom surgery is not feasible.
Jürgensen
Christian
C
Department of Internal Medicine II, Klinikum Chemnitz, Flemmingstrasse 2, D-09116 Chemnitz, Germany.
Schuppan
Detlef
D
Neser
Frank
F
Ernstberger
Jan
J
Junghans
Ulrich
U
Stölzel
Ulrich
U
D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D019160:Endosonography; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006946:Hyperinsulinism / Q000209:etiology; D007340:Insulinoma / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D010190:Pancreatic Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*
D001786:Blood Glucose; D000431:Ethanol