Innovation in the field of endoscopic ultrasound-guided locoregional treatments of pancreatic neuroendocrine tumors

Pancreatic neuroendocrine neoplasms (pNENs) account for approximately 2% of all pancreatic solid tumours. The incidence of pNENs has been steadily rising in recent decades. Clinical presentation varies, with functioning pNENs (such as insulinomas, glucagonomas, and VIPomas) leading to hormone secretion syndromes in 10-30% of patients, while non-functioning pNENs (NF-pNENs) are often diagnosed at more advanced stages or incidentally in asymptomatic individuals. While surgical resection is the recommended treatment for larger, more aggressive tumours, smaller, less proliferative tumours (G1) may be managed with clinical and radiological monitoring. Recently, endoscopic ultrasound (EUS)-guided local ablation techniques, such as ethanol injection (EUS-EI) and radiofrequency ablation (EUS-RFA), have emerged as potential alternatives to surgery. While these techniques show promising results in terms of safety and efficacy, robust evidence supporting their widespread use is still lacking. This review provides an update on the current evidence regarding EUS-guided local therapies for pNENs. The article also discusses patient selection criteria, procedural details, and potential adverse events.