Endoscopic ultrasonography-guided ethanol injection (EUS-EI) is emerging as a promising, minimally invasive treatment for small pancreatic neuroendocrine tumors (PNENs), particularly for patients seeking alternatives to surgery. This approach involves using endoscopic ultrasound to guide the precise injection of ethanol into the tumor, inducing its ablation. The procedure has shown high efficacy in achieving complete tumor ablation and demonstrates a strong safety profile, with minimal risk of severe complications such as pancreatic fistulas or adverse events. Additionally, it appears to preserve pancreatic endocrine function, as most patients did not experience new or worsening diabetes after the procedure. EUS-EI offers a less invasive option compared to traditional surgical methods, making it a potentially suitable choice for patients with small, low-grade PNENs. This treatment is particularly beneficial for carefully selected patients who prioritize reduced recovery time and lower procedural risks.