The Treatment Value Of Endoscopic Ultrasound Guided Fine Needle Injection With Lauromacrogol For Insulinoma Patients

Objective : To investigate the validity,safety and feasibility of endoscopic ultrasound guided fine needle injection(EUS-FNI)with lauromacrogol for insulinoma patients.Methods: We conduct a prospective study with 11 new cases or newly diagnosed cases between April,2016 to December,2018 and their clinical data were collected and analyzed.Results: The average age of the 11 patients(8 female and 3 male patients)when first diagnosed was 42±15.74 years old(ranged from 20 to 72 years old).They all came to our hospital with a chief complaint related to hypoglycemia.After etiologic diagnosis and localization diagnosis as well as pathologic diagnosis gained from EUS guided fine needle aspiration(EUS-FNA),all the patients were diagnosed with insulinoma.9 out of 11 patients(82%)got solitary tumor,and altogether there were 20 lesions,among which 6 were located at the pancreas head(30%),3 at the neck(15%),4 at the body(20%),and 7 at the tail(35%).The tumor size was larger than 2cm(18%)in 2 cases.In total,29 injections were performed for the 11 patients(18 injections were repeated)andthe injection volume for each lesion ranged from 0.9 to 5.3ml.The follow-up time ranged from 3 months to 35 months.Blood glucose,insulin and C-peptide level after the treatment was better than that before the injection in 10 patients.9of the 11 patients got complete symptom-relief while 2 patients could recur after several months or a year after the injection.EUS showed hypoechoic change after EUS-FNI and contrast enhanced harmonic endoscopic ultrasound(CH-EUS)showed hypo-enhanced change after treatment.No complication was found after treatment.Conclusion: EUS-FNI for insulinoma patients with lauromacrogol is safe,efficient and can be conducted repeatedly.With few complication,hospital stay and less cost,it's suitable for patients who can't tolerate or refuse to surgery.Instead of surgery,it might be the first choice for insulinoma patients in the future.Besides,CH-EUS can help to monitor the recurrence during follow-up and help to measure the injection volume when there's repeated treatment.