Objective:

Minimally invasive techniques, including endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA), have been proposed as potential alternatives to surgery for the treatment of pancreatic insulinomas (IP). The aim of this systematic review was to synthesize existing evidence on the safety, efficacy, and long-term outcomes of EUS-RFA compared with traditional surgical approaches. 

Methods:

A systematic search was conducted in PubMed, Scopus, and Embase databases up to 2024. Inclusion was limited to studies reporting on the treatment of IP with either EUS-RFA or surgery that provided data on complications, clinical response, recurrence, and long-term follow-up. Strict selection criteria were applied, and the PRISMA guidelines were followed for the review process. Data on follow-up duration (up to 24–36 months) and monitoring strategies (clinical and radiological) were analyzed as secondary outcomes. 

Results:

Out of 742 identified articles, 22 studies met the inclusion criteria. Evidence indicated that EUS-RFA had a superior safety profile compared with surgery, with a low rate of adverse events. Effectiveness in normalizing glucose levels and controlling hypoglycemic symptoms was similar between the approaches. Long-term follow-up (24–36 months) in most studies showed stability of clinical response, with sporadic recurrences typically managed with repeat EUS-RFA procedures. However, methodological heterogeneity and the limited number of comparative studies remain significant limitations. 

Conclusion:

Current evidence suggests that EUS-RFA represents a safe and effective alternative to surgery for patients with pancreatic insulinoma, offering clear advantages in terms of invasiveness and recovery time. Long-term outcome data are promising, but the evidence remains fragmented. Prospective, comparative, and standardized studies are required to definitively establish the role of EUS-RFA as a first-line therapy.