{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T18:29:00Z","timestamp":1793298540024,"version":"4.5.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Insulinoma is a rare pancreatic neuroendocrine tumor causing hypoglycemia. Surgery is the standard treatment, while endoscopic ultrasound (EUS)-guided ethanol ablation and medical therapy are alternatives in some patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this retrospective study, we recruited 19 patients with insulinoma treated between 2011 and 2025 at National Taiwan University Hospital. The final treatment strategies were surgery (n = 13), EUS-guided ethanol ablation (n = 3), and medical therapy (n = 3). The study outcomes included post-procedure stays (PPS), treatment-related complications, and follow-up results. New-onset diabetes and complete remission rates for insulinoma were examined and compared across treatment modalities. A Firth\u2019s bias-reduced logistic regression analysis was performed to identify predictors of complete remission in 19 patients with insulinoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Patients could receive more than one treatment. Among the three final treatment modalities, surgical resection achieved the highest complete remission rate (13\/13; 100%) but was associated with a longer PPS (mean \u00b1 standard deviation [SD] = 13.46 \u00b1 7.59 days) and a higher incidence of new-onset diabetes (2\/13, 15.38%). EUS-guided ethanol ablation demonstrated moderate efficacy (2\/3; 66.67%) with a comparable PPS (18.33 \u00b1 27.43 days). Lastly, medical therapy relieved symptoms but yielded no complete remissions in insulinoma (0\/3; 0%). Paradoxical hypoglycemia occurred in 2 of 8 patients (25.0%) during octreotide testing or after direct octreotide treatment. One patient with insulin autoimmune syndrome improved after drug withdrawal and multimodal therapy. Logistic regression analysis identified a positive linear effect of baseline glucose levels (mg\/dL) on insulinoma complete remission (estimated adjusted odds ratio [aOR] = 1.2140,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.0461) and ever surgery (yes vs. no) as the most effective treatment for complete remission in insulinoma (aOR = 296.0707,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.0015).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Although surgery was the most effective treatment, it was associated with longer recovery times and potential metabolic risks. EUS-guided ethanol ablation provided a less invasive alternative with a moderate success rate, whereas medical therapy primarily offered symptomatic control rather than a definitive complete remission. Notably, lower baseline glucose levels were associated with treatment resistance, suggesting a potential role in guiding individualized therapeutic strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1848169","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T05:41:14Z","timestamp":1785130874000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical outcomes of medical therapy, EUS-guided ethanol ablation, and surgical resection in insulinoma: a clinical epidemiology study"],"prefix":"10.3389","volume":"17","author":[{"given":"Jin-Ying","family":"Lu","sequence":"first","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital","place":["Taipei, Taiwan"]},{"name":"Department of Laboratory Medicine, National Taiwan University Hospital","place":["Taipei, 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