Endoscopic ultrasonography‐guided ethanol ablation of pancreatic neuroendocrine tumors in multiple endocrine neoplasia type 1 disease following complicated total pancreatectomy

Although pancreatic neuroendocrine tumors (pNETs) account for a small proportion of all pancreatic tumors (1.3%), their incidence is increasing. A 54‐year‐old woman was previously diagnosed with hyperparathyroidism and prolactinoma. A magnetic resonance imaging (MRI) scan showed several oval homogeneous enhancement nodules on the pancreas, with sizes up to 10 mm, and endoscopic ultrasonography (EUS)‐guided fine needle aspiration cytology (FNAC) confirmed the diagnosis of pNETs. Based on her history of primary hyperparathyroidism combined with prolactinoma and her family history of multiple endocrine neoplasia type 1 (MEN1)‐associated tumors, a diagnosis of MEN1 was made. Two months after the surgery, a follow‐up abdominal computed tomography (CT) scan showed a pancreatic remnant that was 15 mm in length, and at the 5‐month follow up, a 6 × 5 mm residual pNET within the pancreatic remnant was detected by EUS, CT, and MRI. Because the patient adamantly refused repeat surgical resection, we decided to ablate the lesion via an EUS‐guided ethanol injection with 1.3 mL and 1.0 mL of 99.5% alcohol in two sessions. At the 4‐month follow up, the contrast‐enhanced MRI showed no residual pNET. Repeated EUS with concurrent FNAC also yielded negative results. We concluded that we achieved a good response after the EUS‐guide ablation. EUS‐guided ethanol ablation is a feasible, safe, and efficient method of treatment when applied for small pNETs in MEN1 disease following complicated total pancreatectomy. However, the long‐term outcomes must be confirmed in future multicenter prospective studies comparing surgical resection and minimally invasive EUS ablation.