Early Gastroenteropancreatic Neuroendocrine Tumors: Endoscopic Therapy and Surveillance

Scherübl, Hans; Cadiot, Guillaume

doi:10.1159/000459404

Cited by 36 publications

(40 citation statements)

References 40 publications

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“…The optimal treatment for subepithelial tumors of the duodenum remains controversial, and the overall data on the safety of endoscopic resection of small bowel carcinoids are limited[1]. If duodenal carcinoids are isolated lesions < 10 mm in size, are low grade, do not infiltrate the muscularis and do not show angioinvasion, EMR is considered by many to be the treatment of choice as they have a very low risk of metastasis, between 6%-10%[2,3]. Current Consensus Guidelines recommend endoscopic removal for small duodenal SET < 10 mm, and consideration of surgical resection for tumors > 20 mm[4].…”

Section: Discussionmentioning

confidence: 99%

“…Current Consensus Guidelines recommend endoscopic removal for small duodenal SET < 10 mm, and consideration of surgical resection for tumors > 20 mm[4]. Tumors between 10 mm-20 mm can be removed either endoscopically or surgically since the risk of metastases noticeably increases when tumor size is ≥ 2 cm[2], and the approach is currently not standardized[4]. However, surgical techniques for duodenal SET resection usually results in a Whipple’s procedure or the more complex pylorus preserving pancreaticoduodenectomy, both associated with significant morbidity and mortality[5].…”

Section: Discussionmentioning

confidence: 99%

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Safety and efficacy of over-the-scope clip-assisted full thickness resection of duodenal subepithelial tumors: A case report

Nassri

Alkhasawneh

Scolapio

et al. 2019

WJGE

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BACKGROUNDOver-the-scope clip-assisted endoscopic full thickness resection (eFTR) of subepithelial tumors is a novel and promising endoscopic technique. Recently, there have been prospective studies investigating its use for colonic masses, but data regarding its use and efficacy in the duodenum are limited to a few reports.CASE SUMMARYA 65-year-old African American female presents for evaluation of persistent gastroesophageal reflux disease not responsive to medical treatment. A 1 cm nodule was incidentally found in the duodenum and biopsies revealed a low grade well differentiated neuroendocrine tumor. The nodule was removed using over-the-scope clip-assisted eFTR and pathology revealed clear margins. We review the available literature with a discussion on the efficacy and safety of clip-assisted eFTR s of subepithelial lesions in the duodenum.CONCLUSIONClip assisted eFTR appears to be a safe and efficacious treatment approach to duodenal subepithelial lesions. Further prospective studies are needed to investigate the long-term utility and safety of clip-assisted eFTR in the management of subepithelial duodenal lesions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of over-the-scope clip-assisted full thickness resection of duodenal subepithelial tumors: A case report

Nassri

Alkhasawneh

Scolapio

et al. 2019

WJGE

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“…ERs are reported to be useful in the treatment of various benign and malignant duodenal lesions, including intramucosal adenocarcinomas, adenomas, lipomas and neuroendocrine tumors (20,(36)(37)(38)(39). The required specific technique (e.g.…”

Section: Discussionmentioning

confidence: 99%

Pathologic evaluation of endoscopically resected non-ampullary duodenal lesions: a single center experience

Taşkin¹,

Aslan²,

Mericoz³

et al. 2019

TJPATH

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Objective: Endoscopic resections are increasingly being used for superficial gastrointestinal lesions. However, application of these techniques in the duodenum remains challenging, due to the technical difficulties and high complication rates. This study projects a western tertiary center's experience in the endoscopic treatment and diagnostic workup of 19 cases of non-ampullary duodenal lesions. Material and Method: Specimens (12 endoscopic mucosal resections, 6 endoscopic submucosal dissections, and one endoscopic full-thickness resection) were processed following a strict protocol (photographed, mapped digitally and submitted totally) for histopathologic examination. Clinicopathologic characteristics, margin status and follow-up information were analyzed. Results: The mean age of the 16 patients was 52 years (range: 22-81). Mean lesion size was 1.4 cm (range: 0.3-3.6 cm) for all cases, 2 cm for endoscopic submucosal dissections and 1.1 cm for endoscopic mucosal resections. Mean number of blocks submitted was 4/case. Seven neuroendocrine tumors, 3 tubulovillous adenomas were diagnosed along with nine benign lesions. For endoscopic submucosal dissections, en-bloc and R0 resection rates were 100% (n=6/6) and 83% (n=5/6); for endoscopic mucosal resections, they were 92% (n=11/12) and 83% (n=10/12), respectively. Only one patient had procedure-related late perforation that was managed endoscopically. No mortality was encountered. Conclusion: Duodenal endoscopic resections proved successful, safe and feasible methods in a tertiary center. The pathologist's role is to designate the accurate diagnosis, related histopathologic parameters and margin status. The gross protocol was found to be essential in evaluating specimen margins and orientation, as well as in size measurement. We recommend following a standardized approach including gross photography and digital mapping when handling these specimens, for both diagnostic and data collection purposes.

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“…The characteristic feature of some NENs is the ability to produce, store and secrete biogenic amines and peptide hormones, such as insulin, gastrin, vasoactive intestinal peptide, glucagon, or somatostatin [3][4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

The Neuroendocrine Neoplasms of the Digestive Tract: Diagnosis, Treatment and Nutrition

et al. 2020

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Nuroendocrine neoplasms (NENs) are a group of rare neoplasms originating from dispersed neuroendocrine cells, mainly of the digestive and respiratory tract, showing characteristic histology and immunoprofile contributing to classification of NENs. Some NENs have the ability to produce biogenic amines and peptide hormones, which may be associated with clinical syndromes like, e.g., the carcinoid syndrome caused by unmetabolized overproduced serotonin, hypoglycemic syndrome in case of insulinoma, or Zollinger-Ellison syndrome accompanying gastrinoma. Diagnostics for these include ultrasound with endoscopic ultrasound (EUS), computed tomography (CT), magnetic resonance imaging (MRI), and positron-emission tomography/computed tomography (PET/CT). Different nuclear medicine procedures can also be used, like somatostatin analogues scintigraphy (SRS) and 68Ga-Dota-Peptide PET/CT, as well as biochemical methods to determine the level of general neuroendocrine markers, such as chromogranin A (CgA), 5-hydroxyindolacetic acid (5-HIAA), synaptopfysin and cell type-specific peptide hormones, and neurotransmitters like gastrin, insulin, serotonin, and histamine. NENs influence the whole organism by modulating metabolism. The treatment options for neuroendocrine neoplasms include surgery, somatostatin analogue therapy, radionuclide therapy, chemotherapy, molecular targeted therapies, alpha-interferon therapy, and inhibitors of serotonin production. In the case of hypersensitivity to biogenic amines, a diet that limits the main sources of amines should be used. The symptoms are usually connected with histamine, tyramine and putrescine. Exogenic sources of histamine are products that take a long time to mature and ferment. Patients with a genetic insufficiency of the diamine oxidase enzyme (DAO), and those that take medicine belonging to the group of monoamine oxidases (MAO), are particularly susceptible to the negative effects of amines. Diet plays an important role in the initiation, promotion, and progression of cancers. As a result of the illness, the consumption of some nutrients can be reduced, leading to nutritional deficiencies and resulting in malnutrition. Changes in metabolism may lead to cachexia in some patients suffering from NENs. The aim of this narrative review was to advance the knowledge in this area, and to determine possibilities related to dietary support. The authors also paid attention to role of biogenic amines in the treatment of patients with NENs. We can use this information to better understand nutritional issues faced by patients with gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs), and to help inform the development of screening tools and clinical practice guidelines.

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Early Gastroenteropancreatic Neuroendocrine Tumors: Endoscopic Therapy and Surveillance

Cited by 36 publications

References 40 publications

Safety and efficacy of over-the-scope clip-assisted full thickness resection of duodenal subepithelial tumors: A case report

Safety and efficacy of over-the-scope clip-assisted full thickness resection of duodenal subepithelial tumors: A case report

Pathologic evaluation of endoscopically resected non-ampullary duodenal lesions: a single center experience

The Neuroendocrine Neoplasms of the Digestive Tract: Diagnosis, Treatment and Nutrition

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