Analysis Of The Complications Prevention Of Endoscopic Ultrasound-Guided Ethanol Ablation On Benign Insulinoma

Objective:To explore the complication may occur of endoscopic ultrasound-guided ethanol ablation on benign insulinoma and its prevention.Methods:Prospective analysis the clinical material of 18 cases diagnosed of benign insulinoma underwent EUS-guided ethanol ablation. To explore the complication may occur of EUS-guided ethanol ablation of benign insulinoma from the preoperative preparation, intraoperative routine operation, postoperative treatment and the norms of follow-up scheme, especially analyzed the complication prevention from the choice of the fine needle, the volume of ethanol injection, approaches of injection, injection speed, injection frequency and so on.Results:In 18 benign insulinoma patients,5 (5/18,27.7%)males, and 13 (13/18,72.3%)females, the male/female ratio was 1:2.6.The age ranged from 24 to 66 years old, with average of (45.8±10.7)years, among which males (44.6± 13.0)years, females (46.3±10.3) years. All the cases were diagnosed with benign insulinoma and were confirmed by smear cytology, liquid-based cytology and block immunohistochemistry by using endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). The mean diameter was(1.3±0.6) cm (range 0.4 cm～2.7 cm),91.3%(21/23) of which were eque to or less than 2cm.The number of tumors was 23. Sixteen cases were single(88.9%), with the tumors in pancreatic head (n=6,26.1%), body(n=9, 39.1%),and tail(n=8,34.8%).Two cases were multiple tumor (11.1%), which one case was found 2 lesions in pancreatic tail, the other case was found 4 lesions in pancreatic tail, and a lesions in the body. A total of 29 treatment sessions (n=18) were performed, including 3 sessions in 3 patients,2 sessions in 5 patients and 1 session in 10 patients. A mean ethanol volume of 0.94mL (range,0.3～3.0mL) was injected per session, and a mean ethanol volume of (1.42±1.14)mL (range,0.3～4.0mL) per patient. The technique success rate was 100%.Patients have been followed a mean of(15.3±7.5)months (range,2～27months) since their last treatment session. No treatment-related complication such as hemorrhage, acute pancreatitis, infection, pancreatic fistula were observed.Conclusion:EUS-guided ethanol ablation on benign insulinoma is improving the clinical symptoms and ablating tumor as the goal, with the method of small doses and repetitive injection. During the procedure, choosing the appropriate fine needle, and the needle passage must be pre-filled with ethanol in pre-operation, the ethanol volume injected is based on the size of the lesions and adjacent relations, paying attention to avoid blood vessels and pancreatic duct, the injection speed must be strictly controlled, which can effectively prevent the occurrence of its complication. EUS-guided ethanol ablation is a new and minimally invasive method, which is expected to use as the clinical treatment of benign insulinoma.