Advanced endoscopic test saves day for repeated spells of unconsciousness

The Institute of Liver, Gastroenterology, and Pancreatic Biliary Sciences at Sir Ganga Ram Hospital recently reported a case of an ectopic insulinoma. A middle-aged female, non-diabetic residing in Dubai was suffering from recurrent episodes of fainting spells, tremors and palpitations over the last 4-6 months. Doctors (in Dubai) evaluated her with multiple abdominal imaging studies like CT, MRI, and other investigations but could not isolate the cause. She then visited ILGPS at SGRH for further evaluation and underwent a minimally-invasive advanced endoscopic procedure called endoscopic ultrasound (EUS)".

According to Dr. Shrihari Anikhindi, Consultant Gastroenterologist and Therapeutic Endoscopist, Institute of Liver Gastroenterology & Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, "Elucidated by saying "EUS (endoscopic ultrasound) is a procedure which allows visualization from within the gastrointestinal tract since the instrument is closer to many organs in the abdomen. Also, it has the added advantage of obtaining a biopsy, which makes it a very useful test for suspected tumors. In this patient, on meticulous screening with EUS, we found a small 1.4 x1.6 cm tumor near the duodenum (1st part of the small intestine). We extracted a sample via a needle (also called FNAC) for testing under a microscope which revealed an insulinoma".

Prof. Anil Arora, added, "Insulinoma is a rare tumor which secretes large amounts of insulin. It is seen as 4 per 10,00,000 (1 million cases). Almost 98% of cases are found in or near the pancreas, but 2% of cases are found elsewhere in the body. These tumors are what we call ectopic or extra-pancreatic insulinomas. These tumors may be easily missed by CT scans and even MRIs. In such cases, endoscopic ultrasound plays a crucial role in finding the tumor. However, even on the EUS, operator experience and skill are confounding factors. Once we localized the tumor via the EUS, the patient was taken for surgical removal".

Dr. Naimish Mehta, GI Surgeon at Sir Ganga Ram Hospital removed the tumor using a minimally invasive laparoscopic approach. Post-removal of the tumor, the patient is now completely symptom-free.

In this video, Dr. Anil Arora, Chairman of the Institute of Liver Gastroenterology & Pancreatic Biliary Sciences at Sir Ganga Ram Hospital, discusses the specifics of the case and shares his expert opinions.