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• W2000248332 abstract "BackgroundWe present a case of a 79 year old Caucasian female with a three year history of hypoglycemic episodes. The patient had a past medical history significant for severe congestive heart failure and atrial fibrillation. Her episodes of hypoglycemia had progressed to the point of requiring a continuous infusion of D25 with ampules of D50 as needed to keep her blood glucose greater than 80. Insulinoma was suspected and work up included a negative sulfonylurea screen, negative insulin antibody and insulin receptor antibody. A CT scan revealed a nodule in the tail of the pancreas, measuring approximately 1cm.Endoscopic methodsUsing a Linear echoendoscope two hypoechoic masses were identified. The larger lesion measured 1.4 x 0.88 cm and was located in the tail of the pancreas, consistent with the nodule seen on the CT scan. A smaller lesion measured 0.54cm and was located in the pancreatic body. Using a 25gauge FNA needle, both lesions were sampled and revealed tissue consistent with insulinoma. The lesions were then each punctured with a 19 guage FNA needle and under ultrasound guidance, the large and small lesions were ablated with 10cc and 2cc of 98% dehydrogenated ethanol,respectively. Both lesions were subsequently unable to be identified on repeat ultrasound view of the pancreas, with hyperechoic bright areas in their place consistant with ethanol injection.Clinical implicationsPancreatic insulinomas are rare, however they are the most common of functional pancreatic neuroendocrine neoplasms. Surgical resection is the treatment of choice and has a high success rate. In this case, the patient had debilitating heart failure and atrial fibrillation with rapid ventricular response, precluding her from surgical resection. To this point, there have been two case reports of alcohol ablation in isolated pancreatic insulinomas reported from Europe. This is the first case of EUS guided ethanol ablation of multiple insulinomas reported in the US. Within 24 hours, the patient was weaned off of the glucose drip and required no additional supplementation to keep blood glucose greater than 90. At follow up 4 months later, no additional hypoglycemic episdodes have occurred. This suggests that the use of EUS guided ethanol ablation in the correclty selected patient population could be a safe alternative to surgical resection. BackgroundWe present a case of a 79 year old Caucasian female with a three year history of hypoglycemic episodes. The patient had a past medical history significant for severe congestive heart failure and atrial fibrillation. Her episodes of hypoglycemia had progressed to the point of requiring a continuous infusion of D25 with ampules of D50 as needed to keep her blood glucose greater than 80. Insulinoma was suspected and work up included a negative sulfonylurea screen, negative insulin antibody and insulin receptor antibody. A CT scan revealed a nodule in the tail of the pancreas, measuring approximately 1cm. We present a case of a 79 year old Caucasian female with a three year history of hypoglycemic episodes. The patient had a past medical history significant for severe congestive heart failure and atrial fibrillation. Her episodes of hypoglycemia had progressed to the point of requiring a continuous infusion of D25 with ampules of D50 as needed to keep her blood glucose greater than 80. Insulinoma was suspected and work up included a negative sulfonylurea screen, negative insulin antibody and insulin receptor antibody. A CT scan revealed a nodule in the tail of the pancreas, measuring approximately 1cm. Endoscopic methodsUsing a Linear echoendoscope two hypoechoic masses were identified. The larger lesion measured 1.4 x 0.88 cm and was located in the tail of the pancreas, consistent with the nodule seen on the CT scan. A smaller lesion measured 0.54cm and was located in the pancreatic body. Using a 25gauge FNA needle, both lesions were sampled and revealed tissue consistent with insulinoma. The lesions were then each punctured with a 19 guage FNA needle and under ultrasound guidance, the large and small lesions were ablated with 10cc and 2cc of 98% dehydrogenated ethanol,respectively. Both lesions were subsequently unable to be identified on repeat ultrasound view of the pancreas, with hyperechoic bright areas in their place consistant with ethanol injection. Using a Linear echoendoscope two hypoechoic masses were identified. The larger lesion measured 1.4 x 0.88 cm and was located in the tail of the pancreas, consistent with the nodule seen on the CT scan. A smaller lesion measured 0.54cm and was located in the pancreatic body. Using a 25gauge FNA needle, both lesions were sampled and revealed tissue consistent with insulinoma. The lesions were then each punctured with a 19 guage FNA needle and under ultrasound guidance, the large and small lesions were ablated with 10cc and 2cc of 98% dehydrogenated ethanol,respectively. Both lesions were subsequently unable to be identified on repeat ultrasound view of the pancreas, with hyperechoic bright areas in their place consistant with ethanol injection. Clinical implicationsPancreatic insulinomas are rare, however they are the most common of functional pancreatic neuroendocrine neoplasms. Surgical resection is the treatment of choice and has a high success rate. In this case, the patient had debilitating heart failure and atrial fibrillation with rapid ventricular response, precluding her from surgical resection. To this point, there have been two case reports of alcohol ablation in isolated pancreatic insulinomas reported from Europe. This is the first case of EUS guided ethanol ablation of multiple insulinomas reported in the US. Within 24 hours, the patient was weaned off of the glucose drip and required no additional supplementation to keep blood glucose greater than 90. At follow up 4 months later, no additional hypoglycemic episdodes have occurred. This suggests that the use of EUS guided ethanol ablation in the correclty selected patient population could be a safe alternative to surgical resection. Pancreatic insulinomas are rare, however they are the most common of functional pancreatic neuroendocrine neoplasms. Surgical resection is the treatment of choice and has a high success rate. In this case, the patient had debilitating heart failure and atrial fibrillation with rapid ventricular response, precluding her from surgical resection. To this point, there have been two case reports of alcohol ablation in isolated pancreatic insulinomas reported from Europe. This is the first case of EUS guided ethanol ablation of multiple insulinomas reported in the US. Within 24 hours, the patient was weaned off of the glucose drip and required no additional supplementation to keep blood glucose greater than 90. At follow up 4 months later, no additional hypoglycemic episdodes have occurred. This suggests that the use of EUS guided ethanol ablation in the correclty selected patient population could be a safe alternative to surgical resection." @default.
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• W2000248332 date "2011-04-01" @default.
• W2000248332 modified "2023-09-25" @default.
• W2000248332 title "VHM10 EUS-Guided Ablation of Pancreatic Insulinomas" @default.
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