P3890 - Endoscopic Ultrasound-Guided Radiofrequency Ablation of an Insulinoma

Rahil Desai, DO¹, Navkiran Randhawa, DO², Ahamed Khalyfa, DO³, Varshita Goduguchinta, DO¹, Mahnoor Inamullah, MD⁴, Sammy Hamad, DO⁵, Diya Mehta, ⁴, Kamran Ayub, MD^6
1Franciscan Health Olympia Fields, Chicago, IL; ²Medical College of Georgia at Augusta University, Augusta, GA; ³University of Iowa, Iowa City, IA; ⁴Southwest Gastroenterology, a Division of GI Partners of Illinois, New Lenox, IL; ⁵Ascension Saint Joseph Medical Center, Joliet, IL; ⁶Silver Cross Hospital, New Lenox, IL

Introduction: Insulinomas are rare neuroendocrine tumors found in the pancreas, with an occurrence of 1 in every 1-4 million people. Patients often present with episodes of severe symptomatic hypoglycemia, along with confusion, diaphoresis, and sometimes seizures. Endoscopic ultrasound guided radiofrequency ablation (EUS-RFA) of insulinomas is a novel technique that can allow for ablation of the tumor with resultant improvement in symptoms. We present a video case of a patient with severe recurrent hypoglycemia due to an insulinoma who was successfully treated with EUS-RFA.

Case Description/Methods: A 41-year old man was referred for evaluation of recurrent hypoglycemia suspected to be secondary to insulinoma with negative computed tomography findings. An EUS was arranged, which revealed a hypervascular tumor in the neck of the pancreas measuring approximately 13.5mm x 8.5mm, with increased echo transmission suggestive of a neuroendocrine tumor (NET). Fine-needle aspiration biopsy confirmed NET consistent with insulinoma. Surgical resection in the form of a Whipple operation was recommended, however, the patient had no form of health insurance and refused surgery due to financial constraints. EUS-RFA was arranged on a charity basis. RFA of the tumor was performed at 20 Watts using a 19G needle. Two applications at 20 and 12 seconds led to complete ablation of the tumor on EUS. During a 4 week follow-up, the patient has had no further episodes of hypoglycemia.

Discussion: Insulinomas are a rare NET of the pancreas that can present as recurrent hypoglycemia and can lead to seizures and even brain damage. Surgical resection remains the treatment of choice, however, when surgery is not an option, EUS-RFA remains a viable treatment modality. Our video presentation demonstrates successful EUS-RFA of an insulinoma with excellent clinical outcome.


Disclosures:


Rahil Desai, DO¹, Navkiran Randhawa, DO², Ahamed Khalyfa, DO³, Varshita Goduguchinta, DO¹, Mahnoor Inamullah, MD⁴, Sammy Hamad, DO⁵, Diya Mehta, ⁴, Kamran Ayub, MD⁶. P3890 - Endoscopic Ultrasound-Guided Radiofrequency Ablation of an Insulinoma, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.