Pancreatic neuroendocrine tumors (NETs) are rare, representing only 1% of all pancreatic tumors. 1 Pancreatic NETs are classified as functional or nonfunctional depending on the presence or absence of a clinical, hormonal hypersecretion syndrome. The clinical management of these lesions is challenging.

For functioning pancreatic NETs, the goal of treatment is to induce necrosis of most of the tumor cells to mitigate hormonal hypersecretion, with cessation of symptoms. 2 Over the past 2 decades, EUS-guided intervention has evolved from a diagnostic method to a therapeutic modality. Because EUS-guided treatment is effective and safe, it can be an alternative for patients with pancreatic NETs, especially for those who are poor surgical candidates or refuse surgery. 3 Herein, we describe a case of EUS-guided ethanol ablation (EA) of metastatic functional insulinoma.