TY  - JOUR
AB  - PURPOSE: Insulinoma is a rare tumor of the pancreas that can lead to hypoglycemia. To date, standard therapy is surgical resection. After first case report of successful endoscopic ultrasound-guided (EUS) ethanol injection 16 years ago, the need of establishing an alternative treatment method is unchanged facing the high morbidity rates of surgery and its inapplicability in some patients. MATERIALS AND METHODS: Here, we provide retrospective data from 33 insulinoma patients that were treated at our center between 2010 and 2021. Of these, 9 patients were treated with EUS-guided ethanol injection and 24 underwent pancreatic surgery. RESULTS: The ethanol group was older (ethanol: mean±SE 67.8±11.2 years vs. surgery: 52.3±15.7, p=0.014) with a higher Charlson Comorbidity Index (3.0 (1.0;4.0) vs. 1.0 (0.0;2.0), p=0.008). Lowest glucose values were similar between groups before (ethanol: 2.09±0.17 mmol/l vs. surgery: 1.81±0.08, p=0.158) and after (4.95±0.74 vs. 5.41±0.28, p=0.581) the respective treatments. Complications occurred more frequently in the surgery group (11 % vs. 54 %, p=0.026). One patient after prior partial pancreatectomy died postoperatively. Hospitalization time was significantly shorter in the ethanol group (4.78±0.78 days vs. 19.88±4.07, p<0.001). CONCLUSION: EUS-guided ethanol injection can be similarly effective for the treatment of hyperinsulinemic hypoglycemia compared with pancreatic surgery but seems to be associated with less severe complications. This implies the need for prospective randomized trials in insulinoma patients with low risk for malignancy.   Ziel: Insulinome sind seltene Tumore des Pankreas, die zu Hypoglykämien führen können. Die chirurgische Resektion ist aktuell Standardtherapie. Nach der ersten Fallbeschreibung einer erfolgreichen EUS-gesteuerten Alkoholinjektion vor 16 Jahren besteht unverändert der Bedarf einer Behandlungsalternative angesichts der hohe operativen Morbidität und der fehlenden Anwendbarkeit bei einigen Patienten. Material und Methode: Wir zeigen die retrospektiven Daten von 33 Insulinom-Patienten, die in unserem Zentrum zwischen 2010 und 2021 behandelt wurden. Von diesen wurden 9 Patienten durch EUS-geführte Alkohol-Injektion und 24 durch Pankreas-Chirurgie behandelt. Ergebnisse: Die Alkohol-Therapie-Gruppe war älter (Alkohol: median±SE 67.8±11.2 Jahre vs. Chirurgie: 52.3±15.7, p=0.014) mit einem höheren Charlson Comorbidity Index (3.0 (1.0;4.0) vs. 1.0 (0.0;2.0), p=0.008). Die niedrigsten Blutzucker waren in beiden Gruppen gleich vor (Alkohol: 2.09±0.17 mmol/l vs. Chirurgie: 1.81±0.08, p=0.158) und nach (4.95±0.74 vs. 5.41±0.28, p=0.581) den jeweiligen Behandlungen. Komplikationen traten häufiger in der Chirurgie-Gruppe auf (11 % vs. 54 %, p=0.026). Ein Patient starb nach partieller Pankreatektomie postoperativ. Die Krankenhausverweildauer war signifikant kürzer in der Alkohol-Gruppe (4.78±0.78 Tage vs. 19.88±4.07, p<0.001). Schlussfolgerungen: Die EUS-gesteuerte Alkoholinjektion kann gleich effektiv sein wie Chirurgie für die Behandlung der hyperinsulinämen Hypoglykämie, scheint aber mit weniger schweren Komplikationen assoziiert zu sein. Hieraus ergibt sich die Notwendigkeit für randomisierte Studien bei Insulinom-Patienten mit niedrigem Malignitäts-Risiko.
AU  - Jürgensen, C.*
AU  - Eckart, M.A.*
AU  - Haberbosch, L.A.*
AU  - Tacke, F.*
AU  - Sandforth, A.
AU  - Birkenfeld, A.L.
AU  - Overkamp, D.*
AU  - Daniels, M.A.*
AU  - Mogl, M.*
AU  - Goretzki, P.A.*
AU  - Strasburger, C.*
AU  - Mai, K.*
AU  - Spranger, J.A.*
AU  - Jumpertz von Schwartzenberg, R.
C1  - 68720
C2  - 54929
CY  - Rudigerstr 14, D-70469 Stuttgart, Germany
TI  - Endoscopic ultrasound-guided ethanol ablation versus surgical resection of insulinomas.
JO  - Ultraschall Med.
PB  - Georg Thieme Verlag Kg
PY  - 2023
SN  - 0172-4614
ER  - 

TY  - JOUR
AB  - Introduction Ultrasound shear wave elastography is well established in diagnostics of several parenchymatous organs and is recommended by respective guidelines. So far, research about applications in relevant neurological conditions is missing, especially in adults. Here we aimed to examine the method for the differentiation of ischemic (IS) and hemorrhagic strokes (HS) and cerebral mass effects. Materials & Methods 50 patients with a confirmed diagnosis of HS or IS were enrolled in this prospective study. 2D shear wave elastography was performed on the ipsilateral and the contralateral side with a modified acoustic radiation force impulse (ARFI) technique (ElastPQ mode, Philips). Lesion volumetry was conducted based on computed tomography data for correlation with elastography results. Results Elastography measurements (EM) revealed a highly significant difference between IS and HS with mean values of 1.94 and 5.50 kPa, respectively (p < 0.00 001). Mean values of brain tissue on the non-affected side were almost identical (IS 3.38 (SD = 0.63); HS 3.35 (SD = 0.66); p = 0.91). With a sensitivity of 0.98 and a specificity of 0.99, a cut-off value of 3.52 kPa for discrimination could be calculated. There was a significant correlation of mass effect represented by midline shift and EM values on the contralateral side (Pearson correlation coefficient = 0.68, p < 0.0003). Conclusion Ultrasound brain parenchyma elastography seems to be a reliable sonographic method for discriminating between large IS and HS and for detecting and tracking conditions of intracerebral mass effects.
AU  - Ertl, M.*
AU  - Woeckel, M.
AU  - Maurer, C.*
C1  - 60391
C2  - 49247
CY  - Rudigerstr 14, D-70469 Stuttgart, Germany
SP  - 75-83
TI  - Differentiation between ischemic and hemorrhagic strokes – a pilot study with transtemporal investigation of brain parenchyma elasticity using ultrasound shear wave elastography.
JO  - Ultraschall Med.
VL  - 42
IS  - 1
PB  - Georg Thieme Verlag Kg
PY  - 2021
SN  - 0172-4614
ER  -