Efficacy and safety of modified endoscopic mucosal resection for rectal neuroendocrine tumors: a meta-analysis

Zheng, Jian-Chun; Zheng, Kai; Zhao, Shuai; Wang, Zhenning; Xu, Hui; Jiang, Chenggang

doi:10.1055/a-1062-8897

Cited by 18 publications

(13 citation statements)

References 37 publications

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“…Even though both ESD and modified EMR were associated with higher rates of complete resection when compared to conventional EMR, this did not translate into a lower risk of clinical recurrence. Two meta-analyses confirmed the superiority of modified EMR over conventional EMR (odds ratio [OR] for histologically complete resection 0.23, 95 %CI 0.10–0.51; P < 0.01), and over ESD (OR 4.08, 95 %CI 2.42–6.88; P < 0.001), with no difference in the adverse event and recurrence rates (< 1 %) 129 130 .…”

Section: Management: Resectionmentioning

confidence: 92%

Endoscopic management of subepithelial lesions including neuroendocrine neoplasms: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2022

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Main Recommendations 1 ESGE recommends endoscopic ultrasonography (EUS) as the best tool to characterize subepithelial lesion (SEL) features (size, location, originating layer, echogenicity, shape), but EUS alone is not able to distinguish among all types of SEL.Strong recommendation, moderate quality evidence. 2 ESGE suggests providing tissue diagnosis for all SELs with features suggestive of gastrointestinal stromal tumor (GIST) if they are of size > 20 mm, or have high risk stigmata, or require surgical resection or oncological treatment.Weak recommendation, very low quality evidence. 3 ESGE recommends EUS-guided fine-needle biopsy (EUS-FNB) or mucosal incision-assisted biopsy (MIAB) equally for tissue diagnosis of SELs ≥ 20 mm in size.Strong recommendation, moderate quality evidence. 4 ESGE recommends against surveillance of asymptomatic gastrointestinal (GI) tract leiomyomas, lipomas, heterotopic pancreas, granular cell tumors, schwannomas, and glomus tumors, if the diagnosis is clear.Strong recommendation, moderate quality evidence. 5 ESGE suggests surveillance of asymptomatic esophageal and gastric SELs without definite diagnosis, with esophagogastroduodenoscopy (EGD) at 3–6 months, and then at 2–3-year intervals for lesions < 10 mm in size, and at 1–2-year intervals for lesions 10–20 mm in size. For asymptomatic SELs > 20 mm in size that are not resected, ESGE suggests surveillance with EGD plus EUS at 6 months and then at 6–12-month intervals.Weak recommendation, very low quality evidence. 6 ESGE recommends endoscopic resection for type 1 gastric neuroendocrine neoplasms (g-NENs) if they grow larger than 10 mm. The choice of resection technique should depend on size, depth of invasion, and location in the stomach.Strong recommendation, low quality evidence. 7 ESGE suggests considering removal of histologically proven gastric GISTs smaller than 20 mm as an alternative to surveillance. The decision to resect should be discussed in a multidisciplinary meeting. The choice of technique should depend on size, location, and local expertise.Weak recommendation, very low quality evidence. 8 ESGE suggests that, to avoid unnecessary follow-up, endoscopic resection is an option for gastric SELs smaller than 20 mm and of unknown histology after failure of attempts to obtain diagnosis.Weak recommendation, very low quality evidence. 9 ESGE recommends basing the surveillance strategy on the type and completeness of resection. After curative resection of benign SELs no follow-up is advised, except for type 1 gastric NEN for which surveillance at 1–2 years is advised.Strong recommendation, low quality evidence. 10 For lower or upper GI NEN with a positive or indeterminate margin at resection, ESGE recommends repeating endoscopy at 3–6 months and another attempt at endoscopic resection in the case of residual disease.Strong recommendation, low quality evidence.

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Section: Management: Resectionmentioning

confidence: 92%

Endoscopic management of subepithelial lesions including neuroendocrine neoplasms: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2022

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“…Electronic medical record data mining is a new research field used for production and development to meet the above needs. It can explore the hidden rules and standards of medical diagnosis in the electronic medical record system and provide assistant decision-making for physicians in the diagnosis and treatment of diseases [13].…”

Section: Data Mining Of Electronic Medical Recordsmentioning

confidence: 99%

“…e experiment included data on 3455 women who notified pregnancy between 1999 and 2012. e development of a diet-based diabetes risk score in the study aims to quantify the association between adherence to the prior diet score and the incidence of type 2 diabetes,; among the 9 food categories for which diet scores (reported to be negatively correlated with the incidence of type 2 diabetes), 3 food categories are reported to be directly related to type 2 diabetes. Donazar-Ezcurra M assessed three types of compliance with diet-based diabetes risk scores: low (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24), intermediate (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39), and high (40-60). Compared with the lowest category, the higher category showed an independent inverse correlation with the risk of developing gestational diabetes (multivariate-adjusted OR 0•48; 95% CI 0•24, 0•99; linear trend P: 0•01).…”

Section: Introductionmentioning

confidence: 99%

Diabetes Risk Data Mining Method Based on Electronic Medical Record Analysis

Liu

Yang

2021

Journal of Healthcare Engineering

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In today’s society, the development of information technology is very rapid, and the transmission and sharing of information has become a development trend. The results of data analysis and research are gradually applied to various fields of social development, structured analysis, and research. Data mining of electronic medical records in the medical field is gradually valued by researchers and has become a major work in the medical field. In the course of clinical treatment, electronic medical records are edited, including all personal health and treatment information. This paper mainly introduces the research of diabetes risk data mining method based on electronic medical record analysis and intends to provide some ideas and directions for the research of diabetes risk data mining method. This paper proposes a research strategy of diabetes risk data mining method based on electronic medical record analysis, including data mining and classification rule mining based on electronic medical record analysis, which are used in the research experiment of diabetes risk data mining method based on electronic medical record analysis. The experimental results in this paper show that the average prediction accuracy of the decision tree is 91.21%, and the results of the training set and the test set are similar, indicating that there is no overfitting of the training set.

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“…Due to the potential risk of metastasis of rectal NETs, it is of critical importance to guarantee the H-CR of the tumor during endoscopic treatment. Many studies have proven that, for rectal NETs smaller than 10 mm in diameter, modified EMR affords a higher rate of H-CR than does conventional EMR (13,31). Yang et al (32) showed that for rectal NETs 6-8 mm in diameter, there was no significant difference in the H-CR rate between modified EMR and ESD.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, in situ tumors ≤10 mm in diameter and confined to the mucosa and submucosa are acknowledged to have a low risk of lymph node metastases and can be treated locally with endoscopic resection (11). Endoscopic treatment approaches include conventional endoscopic mucosal resection (EMR), modified EMRs such as cap-assisted EMR (EMR-C) and ligation-assisted endoscopic mucosal resection (EMR-L), and endoscopic submucosal dissection (ESD) (12,13). Currently, most guidelines recommended modified EMR or ESD for the endoscopic treatment of rectal NETs to improve histologically complete resection of the lesion and to reduce the rate of residual tissue (14,15).…”

Section: Introductionmentioning

confidence: 99%

Prognosis of rectal neuroendocrine tumors after endoscopic resection: a single-center retrospective study

Zheng¹,

Guo²,

Zeng³

et al. 2021

J Gastrointest Oncol

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Background: The efficacy of endoscopic resection in patients with rectal neuroendocrine tumors (NETs) which are less than 20 mm in diameter remains unclear. This study aimed to investigate the efficacy and outcomes of different types of endoscopic resection in patients with NETs.Methods: We performed a retrospective analysis and follow-up on 98 patients who underwent endoscopic resection for rectal NETs between August 2010 and October 2019 at Guangdong Provincial People's Hospital, China. The lesions were preoperatively classified according to their endoscopic morphology and measured by endoscopic ultrasound. Patients were divided into modified endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) groups depending on the endoscopic treatment they received.The en bloc resection rate, histopathological complete resection rate, and the complication rate of the 2 groups were evaluated after the operation. The risk factors for incomplete resection were also analyzed. Results:The average diameter of the 98 NETs was 6.29±2.90 mm (range, 2-15 mm). The en bloc resection rate of the modified EMR and ESD treatment groups was 97.2% (35/36) and 100% (62/62), respectively. The histopathological complete resection rate was 86.1% (31/36) and 87.1% (54/62), respectively. No tumor recurrence or tumor-related death occurred. There were no statistically significant differences in the rate of histopathological complete resection, perforation, or delayed hemorrhage between the 2 groups (P>0.05).Multivariate analysis demonstrated that the depth of tumor invasion (P=0.007) and tumor diameter (P<0.001) were independent risk factors for histopathological complete resection.Conclusions: Modified EMR and ESD are safe and effective endoscopic approaches for the resection of rectal NETs ≤15 mm in diameter. Endoscopic resection requires a comprehensive preoperative evaluation of risk factors including the depth of tumor invasion and tumor diameter.

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Efficacy and safety of modified endoscopic mucosal resection for rectal neuroendocrine tumors: a meta-analysis

Cited by 18 publications

References 37 publications

Endoscopic management of subepithelial lesions including neuroendocrine neoplasms: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Endoscopic management of subepithelial lesions including neuroendocrine neoplasms: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Diabetes Risk Data Mining Method Based on Electronic Medical Record Analysis

Prognosis of rectal neuroendocrine tumors after endoscopic resection: a single-center retrospective study

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