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  • Title: Contrast-enhanced endoscopic ultrasonography improves the preoperative localization of insulinomas.
    Author: Kasono K, Hyodo T, Suminaga Y, Sugiura Y, Namai K, Ikoma A, Tamemoto H, Imawari M, Kawakami M, Ishikawa SE.
    Journal: Endocr J; 2002 Aug; 49(4):517-22. PubMed ID: 12402985.
    Abstract:
    We report a case in which endoscopic ultrasonography (EUS), intraductal ultrasonography (IDUS) and contrast-enhanced EUS using Levovist helped to localize insulinoma correctly. A 74-year-old woman complained of symptomatic fasting hypoglycemia with relatively high concentration of serum insulin level. Dynamic contrast-enhanced computed tomography revealed a small tumor of 8 mm diameter in the pancreatic head. Insulin secretion was strongly stimulated by calcium injection into the gastroduodenal artery. To clarify the precise localization, we performed EUS, IDUS and contrast-enhanced EUS. The tumor was enhanced clearly by Levovist, and the distance from the main pancreatic duct was more than 3 mm. Therefore, a preoperative decision could be made to use the enucleation method for resection of the tumor. The surgeon could enucleate the tumor in a brief operation according to the preoperative diagnosis, and serum glucose levels returned to normal range after the operation. Contrast-enhanced EUS using Levovist was shown to be a useful diagnostic method for precise localization of small insulinoma.
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