Successful Endoscopic Ultrasound-Guided Radiofrequency Ablation for Symptomatic Insulinoma in a High-Risk Elderly Patient

We describe a case of symptomatic pancreatic insulinoma in an 80-year-old man with multiple comorbidities. The patient underwent endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA). After biochemical suspicion of endogenous hyperinsulinemic hypoglycemia, imaging revealed a 9 × 18 mm pancreatic body mass confirmed as a World Health Organization grade 1 insulinoma on histopathology. Given the high surgical risk, we performed a EUS-RFA with 13 sequential ablations. Blood glucose normalized within 48 hours postprocedure. The lesion reduced significantly in size, with no recurrence of hypoglycemia observed up to an 18-month follow-up. EUS-RFA offers a safe and effective alternative to surgery for insulinoma in medically vulnerable patients.