AUTHOR=Bendix Julie , Laursen Mette G. , Mortensen Michael B. , Melikian Maria , Globa Evgenia , Detlefsen Sönke , Rasmussen Lars , Petersen Henrik , Brusgaard Klaus , Christesen Henrik T. 

TITLE=Intraoperative Ultrasound: A Tool to Support Tissue-Sparing Curative Pancreatic Resection in Focal Congenital Hyperinsulinism

JOURNAL=Frontiers in Endocrinology

VOLUME=9

YEAR=2018

URL=https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2018.00478

DOI=10.3389/fendo.2018.00478

ISSN=1664-2392

ABSTRACT=<p><bold>Background:</bold> Focal congenital hyperinsulinism (CHI) may be cured by resection of the focal, but often non-palpable, pancreatic lesion. The surgical challenge is to minimize removal of normal pancreatic tissue.</p><p><bold>Aim:</bold> To evaluate the results of intraoperative ultrasound-guided, tissue-sparing pancreatic resection in CHI patients at an international expert center.</p><p><bold>Methods:</bold> Retrospective study of CHI patients treated at Odense University Hospital, Denmark, between January 2010 and March 2017.</p><p><bold>Results:</bold> Of 62 consecutive patients with persistent CHI, 24 (39%) had focal CHI by histology after surgery. All patients had a paternal <italic>ABCC8</italic> or <italic>KCNJ11</italic> mutation and a focal lesion by <sup>18</sup>F-DOPA-PET/CT. Intraoperative ultrasound localized the focal lesion in 16/20 patients (sensitivity 0.80), including one ectopic lesion in the duodenal wall. Intraoperative ultrasound showed no focal lesion in 11/11 patients with diffuse CH (specificity 1.0). The positive predictive value for focal histology was 1.0, negative predictive value 0.73.</p><p>Tissue-sparing pancreatic resection (focal lesion enucleation, local resection of tail or uncinate process) was performed in 67% (<italic>n</italic> = 16). In 11/12 having tissue-sparing resection and intraoperative ultrasound, the location of the focal lesion was exactly identified. Eight patients had resection of the pancreatic head or head/body, four with Roux-en-Y, three with pancreatico-gastrostomy and one without reconstruction. None had severe complications to surgery. Cure of hypoglycaemia was seen in all patients after one (<italic>n</italic> = 21) or two (<italic>n</italic> = 3) pancreatic resections.</p><p><bold>Conclusion:</bold> In focal CHI, tissue-sparing pancreatic resection was possible in 67%. Intraoperative ultrasound was a helpful supplement to the mandatory use of genetics, preoperative <sup>18</sup>F-DOPA-PET/CT and intraoperative frozen sections.</p>