Aug. 21, 2025
Insulinoma is the most common type of functional pancreatic neuroendocrine tumor. Patients with insulinomas typically exhibit signs and symptoms attributable to hypoglycemia. Treatment of insulinomas has traditionally favored surgical enucleation for small and peripherally located lesions. Partial pancreatectomy is used for larger tumors or those near the main pancreatic duct.
However, new data from Mayo Clinic shows ethanol ablation is a promising adjunct to traditional surgical options, providing an alternative treatment option for tumors that are unfavorably positioned for enucleation or straightforward resection.
A recent study published in the Journal of Surgical Research highlights the effectiveness of ethanol ablation for insulinoma. In this study, all patients demonstrated reduced hypoglycemic episodes, with the majority experiencing complete resolution of their symptoms after treatment with ethanol ablation.
"Ethanol ablation is a great alternative to the Whipple procedure, especially in patients with multiple comorbidities who cannot tolerate the postoperative challenges associated with such an operation."
This technique can be performed in a procedural suite guided by endoscopic ultrasound (EUS), or it can be employed during a surgical procedure guided by intraoperative ultrasound (IOUS). This study includes both approaches and reports both to be highly successful.
Travis J. McKenzie, M.D., an endocrine surgeon at Mayo Clinic in Rochester, Minnesota, states: "Intraoperative ethanol ablation can be used for tumors that are found to be too close to the main pancreatic duct for enucleation at the time of surgery, especially lesions in the head of pancreas where resection is challenging."
Adrian Vella, M.D., an endocrinologist at Mayo Clinic in Rochester, Minnesota, adds: "Ethanol ablation is a great alternative to the Whipple procedure, especially in patients with multiple comorbidities who cannot tolerate the postoperative challenges associated with such an operation."
Overall, clinicians at Mayo Clinic are excited about adding ethanol ablation to their treatment armamentarium for patients with insulinomas. The technique appears to be safe, effective and offers the greatest degree of pancreas preservation, which can be especially important for patients with a predisposition to multifocal insulinoma — such as with multiple endocrine neoplasia, type 1 (MEN1) — and for patients who have had prior pancreas resection.
The ability to perform ethanol ablation through EUS and avoid surgery altogether is especially intriguing. Technological advances such as this continue to revolutionize Mayo Clinic's approach to functional pancreatic neuroendocrine tumors.
For more information
Sada A, et al. Ethanol ablation for benign insulinoma: Intraoperative and endoscopic approaches. Journal of Surgical Research 2024;293:663.
Refer a patient to Mayo Clinic.