LAUSR

Figure 2. Pretreatment EUS image of radiofrequency ablation needle inserted into tumor. EUS-guided radiofrequency ablation (RFA) is an endoscopic procedure and emerging therapeutic option for the treatment of pancreatic tumors. It has been described in recent years for local therapy of pancreatic adenocarcinoma and neuroendocrine tumors in patients for whom operative management is deemed unsuitable. Hyperthermic ablation using radiofrequency waves at 500 kHz is used to induce irreversible cellular injury and necrosis of the target lesion. Precise delivery of thermal energy is critical to spare the normal surrounding pancreatic tissue from injury. There is a modest but growing body of literature regarding the use of this technique in pancreatic neuroendocrine tumors, and our case demonstrates the feasibility of achieving immediate and durable response. A 66-year-old woman with morbid obesity and type 2 diabetes was referred for management of a pancreatic insulinoma after multiple episodes of hypoglycemia. Biochemical markers were diagnostic of an insulinoma, with a fasting C-peptide level of 4 (reference: 0.8-3.5) and serum insulin of 27 mIU/L (reference: <25 mIU/L) in the setting of a fasting glucose level of 44 mg/dL (reference: 65-95 mg/ dL). CT imaging revealed an early arterial phase-enhancing lesion measuring 1.8 0.9 1.3 cm in the pancreatic head (Fig. 1). After a multidisciplinary discussion, the patient was deemed a high-risk surgical candidate because of her comorbidities, and it was therefore decided to offer EUSguided RFA of the tumor. The patient was admitted to the hospital for glucose monitoring before the procedure. Outpatient diazoxide, which was used to maintain her blood glucose, was discontinued before the procedure (T1⁄2 24-36 hours). Informed