ENDOSCOPIC ULTRASOUND-GUIDED RADIOFREQUENCY ABLATION VERSUS SURGICAL RESECTION FOR TREATMENT OF PANCREATIC INSULINOMA

Background and aims: Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is emerging as a safe and effective treatment for pancreatic neuroendocrine tumors. We aimed to compare EUS-RFA and surgical resection for the treatment of pancreatic insulinoma (PI). Methods: Patients with sporadic PI who underwent EUS-RFA at 23 centers or surgical resection at eight high-volume pancreatic surgery institutions between 2014 and 2022 were retrospectively identified and outcomes compared using a propensity-matching analysis. Primary outcome was safety. Secondary outcomes were clinical efficacy, hospital stay, and recurrence rate after EUS-RFA. Results: Using propensity score matching, 89 patients were allocated in each group (1:1), and were evenly distributed in terms of age, sex, Charlson comorbidity index, ASA score, BMI, distance between lesion and main pancreatic duct, lesion site, size, and grade. Adverse events (AEs) rate was 18.0% and 61.8% after EUS-RFA and surgery, respectively (P<0.001). No severe AEs were observed in the EUS-RFA group compared with 7.8% after surgery (P=0.0002). Clinical efficacy was 100% after surgery and 95.5% after EUS-RFA (P=0.160). However, the mean duration of follow-up time was shorter in the EUS-RFA group (median 23 months, IQR 14-31, vs 37 months, IQR 17.5-67, in the surgical group, P<0.0001). Hospital stay was significantly longer in the surgical group (11.1±9.7 vs 3.0±2.5 days in the EUS-RFA group, P<0.0001). Fifteen (16.9%) lesions recurred after EUS-RFA and underwent a successful repeat EUS-RFA (11 pts) or surgical resection (4 pts). Conclusion: EUS-RFA is safer than surgery and highly effective for the treatment of PI. If confirmed in a randomized study, EUS-RFA treatment can become first line therapy for sporadic PI