EUS-RFA Versus Surgery for Pancreatic Insulinoma (ERASIN-RCT)

Inclusion Criteria: * Age ≥18 years * Diagnosis of pancreatic insulinoma (38) (e.g., fasting test, insulin blood levels, C-peptide blood levels) * Presence of a visible single pancreatic nodule on imaging (computed tomography, and/or magnetic resonance imaging, and/or endoscopic ultrasound). * No evidence of distant localizations visualized at computed tomography, and/or magnetic resonance imaging, and/or endoscopic ultrasound * Tumor ≤ 2cm * Informed consent provided by the patient or closest relative. Exclusion Criteria: * G2 with Ki-67 \>5% on histological examination at EUS-guided biopsy samples (if performed) * Distance between lesion and main pancreatic duct ≤ 1mm or upstream dilation of the main pancreatic duct * Metastatic tumor at the time of diagnosis * Multiple pancreatic nodules * Diagnosis of multiple endocrine neoplasia type 1 according to guidelines * Unfit for surgery or high-risk surgical patients * Endoscopic ultrasound not feasible for surgical altered anatomy * Known bleeding disorder that cannot be sufficiently corrected with co-fact or fresh frozen plasma * Use of anticoagulants that cannot be discontinued * International normalized ratio \>1.5 or platelet count \<50.000 * Pregnancy or breast feeding * Failure to sign the patient's or closest relative's informed consent