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

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