2023 Volume 38 Issue 4 Pages 229-237
The first endoscopic ultrasound (EUS)-guided ablation therapy for symptom palliation of pancreatic neuroendocrine neoplasms (PNENs) was ethanol injection for insulinomas performed in patients with impaired tolerance for surgery, resulting in improved hypoglycemic symptoms. Subsequent several case reports have reported the usefulness of EUS-guided ethanol injection therapy (EUS-EIT) for symptom palliation with insulinoma smaller than 15mm. However, complete ablation rate of EUS-EIT for non-functional PNENs is not high, less than 80%. The complete ablation rate of EUS-guided radiofrequency ablation (EUS-RFA) is higher, but the rate of serious complications is believed higher compared with EUS-EIT. Furthermore, the necessity of aggressive treatment for low-grade PNENs <10mm is still controversial. In addition to accumulating evidence, long-term prognosis requires examination to determine the size of PNEN indicated and whether ethanol injection therapy or radiofrequency ablation is the best treatment.
