Outcomes of endoscopic ultrasound-guided ablation and minimally invasive surgery in the treatment of pancreatic insulinoma: a systematic review and meta-analysis

Dan Xiao; Li Zhu; Si Xiong; Xu Yan; Qin Jiang; Ao Wang; Yegui Jia

doi:10.3389/fendo.2024.1367068

Outcomes of endoscopic ultrasound-guided ablation and minimally invasive surgery in the treatment of pancreatic insulinoma: a systematic review and meta-analysis

Front Endocrinol (Lausanne). 2024 Apr 5:15:1367068. doi: 10.3389/fendo.2024.1367068. eCollection 2024.

Authors

Dan Xiao^#¹, Li Zhu^#², Si Xiong³, Xu Yan⁴, Qin Jiang¹, Ao Wang¹, Yegui Jia¹

Affiliations

¹ Department of Gastroenterology, The Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan, Hubei, China.
² Gastrointestinal Surgery, The Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan, Hubei, China.
³ Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, Hubei, China.
⁴ Internal Medicine Department, University Hospital, Wuhan Institute of Technology, Wuhan, Hubei, China.

^# Contributed equally.

Abstract

Background and aims: Most pancreatic insulinomas can be treated by minimally invasive modalities. The aim of this meta-analysis was to assess the clinical outcomes of endoscopic ultrasound (EUS)-guided ablation and minimally invasive surgery (MIS) in the treatment of pancreatic insulinoma.

Materials and methods: Online databases were searched for relevant studies. The primary aim was to compare the rates of adverse events (AEs) and the secondary aims were to compare the clinical and technical success rates, length of hospital stays, and symptom recurrence rates between EUS and MIS approaches.

Results: Eight studies with 150 patients were identified that reported EUS-guided ablation outcomes, forming the EUS group, and 9 studies with 236 patients reported MIS outcomes, forming the MIS group. The pooled median age of the included patients in the EUS group was greater than that of the MIS group (64.06 vs. 44.98 years old, p < 0.001). Also, the technical success rate was significantly higher in the EUS group (100% vs. 96.6%, p = 0.025), while the clinical success was significantly higher (6%) in the MIS group (94% vs. 98.7%, p = 0.021). The AE rates (18.7% vs. 31.1%, p = 0.012) and severe AE rates (1.3% vs. 7.9%, p = 0.011) were significantly lower in the EUS group. The median length of hospital stay in the EUS group (2.68 days, 95% CI: 1.88-3.48, I^{2 =}60.3%) was significantly shorter than in the MIS group (7.40 days, 95% CI: 6.22-8.58, I^{2 =}42.2%, p < 0.001). The recurrence rate was significantly higher in the EUS group (15.3% vs. 1.3%, p < 0.001).

Conclusions: EUS-guided ablation is associated with a lower AE rate and a shorter length of hospital stay, but a higher recurrence rate for the treatment of insulinoma compared with MIS. The EUS approach may be an alternative, even first-line, treatment for poor surgery candidates.

Keywords: ablation; adverse event; clinical outcomes; endoscopic ultrasound; insulinoma; minimally invasive surgery.

Publication types

Systematic Review
Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Endosonography* / methods
Humans
Insulinoma* / diagnostic imaging
Insulinoma* / surgery
Length of Stay / statistics & numerical data
Minimally Invasive Surgical Procedures* / methods
Pancreatic Neoplasms* / surgery
Treatment Outcome

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This work was supported by the scientific research projects of the Chinese Medicine Administrative Bureau of Hubei Province (No. ZY2023F065) and the Seventh batch of Young and middle-aged medical Backbone Personnel Training Project in Wuhan in 2019 (No: Wuweitong [2019] 87).