Alcohol-free EUS-guided chemoablation of multiple pancreatic insulinomas

Background and study aims  Endoscopic ultrasound (EUS)-guided chemoablation with ethanol lavage, followed by infusion with paclitaxel, has been found to be effective for treatment of mucinous pancreatic cysts. However, there are notable adverse events (AEs) associated with ethanol and its undesirable inflammatory effects on local tissue and vessels. The recent ChARM trial demonstrated that removing ethanol from the cyst ablation process resulted in equivalent efficacy while significantly reducing associated AEs. Encouraged by these results, we speculated that alcohol-free chemoablation can be applied to treatment of solid tumors, as described in our case with a patient with severe and symptomatic recurrent hypoglycemia in the setting of multifocal insulinomas. As a result, the patient saw a significant reduction in symptoms. EUS-guided alcohol-free chemoablation may represent a new alternative to previously established therapies that will ultimately reduce risk of AEs.