SHM Converge Scientific Abstract ePoster Gallery-Endoscopic Ultrasound-Guided Radiofrequency Ablation of an Insulinoma: A Minimally Invasive, Hospitalist-Driven Solution in a High-Risk Surgical Candidate

Endoscopic Ultrasound-Guided Radiofrequency Ablation of an Insulinoma: A Minimally Invasive, Hospitalist-Driven Solution in a High-Risk Surgical Candidate

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This case report describes a 73-year-old woman with a 10-year history of recurrent hypoglycemia caused by an insulinoma, a rare functional pancreatic neuroendocrine tumor and the most common cause of endogenous hyperinsulinemic hypoglycemia. Imaging showed a small hypervascular lesion in the pancreatic head, measuring about 16–18 mm, located very close to the main pancreatic duct. Because of this high-risk anatomy, standard curative surgery would likely have required pancreaticoduodenectomy, which carried substantial morbidity for an older, medically complex patient.<br /><br />A hospitalist recognized endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) as a minimally invasive, organ-preserving alternative. The hospitalist coordinated multidisciplinary evaluation and access to tertiary resources, despite EUS-RFA not being included in the national health catalog. This became the institution’s first EUS-RFA for insulinoma.<br /><br />The patient underwent EUS-RFA with concurrent biopsy without complications. Pathology confirmed a well-differentiated Grade 1 pancreatic neuroendocrine tumor with a Ki-67 index of 1%. After treatment, her hypoglycemia resolved completely, and outpatient follow-up over six months showed stable normal glucose levels around 70 mg/dL.<br /><br />The report concludes that EUS-RFA can be a safe and effective option for small insulinomas located near critical structures, offering an alternative to high-risk surgery. It also highlights the important role hospitalists can play in identifying innovative treatments, coordinating care, and improving access for complex patients.

Asset Subtitle

Lucas Gortz

Meta Tag

Author List Djuliany Siqueira, Eduardo Bonin, Fernanda Panacioni Lippmann, Gabriel Rezende, Jacqueline Bernardin, Lucas Gortz, Mariana Baptista, Mateus Krik, Mauricio Carvalho, Rafaela Angonese

Category Clinical Vignettes

Concept Insulinoma

Concept Endogenous Hyperinsulinemic Hypoglycemia

Concept Pancreatic Neuroendocrine Tumor

Concept Surgical Resection

Concept Endoscopic Ultrasound

Distinguished Non-Finalist

Presenter Organization Complexo Hospital De Clínicas - Universidade Federal Do Paraná (CHC-UFPR)

Presenting Author Lucas Gortz

Track Adult

Keywords

insulinoma

hypoglycemia

endoscopic ultrasound-guided radiofrequency ablation

EUS-RFA

pancreatic neuroendocrine tumor

pancreatic head lesion

minimally invasive treatment

hospitalist care coordination

endogenous hyperinsulinemic hypoglycemia

organ-preserving therapy

Insulinoma

Endogenous Hyperinsulinemic Hypoglycemia

Pancreatic Neuroendocrine Tumor

Surgical Resection

Endoscopic Ultrasound