Efficacy of Endoscopic Mucosal Resection for Management of Small Duodenal Neuroendocrine Tumors

Shroff, Sagar; Kushnir, Vladimir; Wani, Sachin; Gupta, Neil; Jonnalagadda, Sreenivasa S.; Murad, Faris; Early, Dayna S.; Mullady, Daniel; Edmundowicz, Steven A.; Azar, Riad R.

doi:10.1097/sle.0000000000000192

Cited by 23 publications

(18 citation statements)

References 19 publications

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“…Die in über 90 % weniger als 2 cm messenden und funktionell nicht in Erscheinung tretenden Tumoren zeigen immunhistochemisch meist eine Expression für Somatostatin, bei erhöhter Ki-67-Rate dagegen vermehrt eine Calcitonin-Expression. In beiden Fällen ist bei kleinem Primärtumor und Fehlen hormoneller Symptome die endoskopische Entfernung der rein submukösen Tumore ausreichend [303,304].…”

Section: Pankreas-netunclassified

S2k-Leitlinie Neuroendokrine Tumore

Gastroenterologie¹,

Tumoren²,

e.V.³

et al. 2018

Z Gastroenterol

130

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Section: Pankreas-netunclassified

S2k-Leitlinie Neuroendokrine Tumore

Gastroenterologie¹,

Tumoren²,

e.V.³

et al. 2018

Z Gastroenterol

130

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“…EMR technique was successful and safe treatment options for most small D‐NETs [7]. This safety issue was confirmed by more and more recent case series reported in the literatures [8,9]. Moreover, the EUS plays an important and unique role in the case of D‐NETs in evaluating the depth of invasion of the duodenal wall and in assistance for initial treatment strategy made.…”

Section: Discussionmentioning

confidence: 87%

Metachronous duodenal neuroendocrine neoplasms after endoscopic mucosal resection

Wang

Liang

et al. 2017

Adv in Digestive Medicine

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Summary Duodenal neuroendocrine tumors (D‐NETs) may or may not be associated with a functional clinical syndrome. The term D‐NETs includes all duodenal tumors with neuroendocrine features as determined by histological/ immunohistochemical methods including positivity for neuroendocrine cytosolic markers (neuron‐specific enolase, or secretory vesicle proteins (chromogranin A (CgA), synaptophysin)). More than 90% of all D‐NETs arise in the first and second part of the duodenum. Approximately 20% of D‐NETs occurs in the periampullary region. Most D‐NETs are asymptomatic and incidentally detected during upper gastrointestinal (GI) endoscopy examinations for symptoms unrelated to the carcinoid tumor. D‐NETs account for 2% ‐ 5% of GI neuroendocrine tumors, and usually present as solitary small lesions confined to the duodenal submucosa. Endoscopic treatment is generally recommended for D‐NETs less than 10 mm as it is associated with a low frequency of lymph node invasion and distant metastases. However, the report of metachronous or synchronous concurrence of D‐NETs is scarce. Herein, we present a case of metachronous duodenal neuroendocrine tumor status successfully treated by hybrid endoscopic submucosal dissection. Copyright © 2017, The Gastroenterological Society of Taiwan, The Digestive Endoscopy Society of Taiwan and Taiwan Association for the Study of the Liver.

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“…[4] Another study reported that duodenal carcinoid tumors are indolent when they are small (<10–20 mm) and localized in the submucosa. [7,11] The malignancy features of duodenal carcinoid tumors embedded in the submucosa are angioinvasion, high mitotic figures, and larger lesion size. [4] In the present study, we performed EMR for duodenal carcinoid tumors without malignant features.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of ligation-assisted endoscopic resection for duodenal neuroendocrine tumors

et al. 2018

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Duodenal carcinoid tumors, a type of neuroendocrine tumors, are relatively rare and are usually found incidentally during endoscopy. Small duodenal carcinoid tumors (≤10-20 mm), embedded in the submucosa, can be resected endoscopically because of the low risk of metastasis. The aim of this study was to assess the safety and efficacy of ligation-assisted endoscopic mucosal resection (EMR) for the treatment of small duodenal carcinoid tumors. The clinical outcomes of the endoscopic procedures were also evaluated.Between November 2008 and November 2017, a total of 15 duodenal carcinoid tumors embedded in the submucosa were resected using EMR. Two types of EMR (conventional EMR and ligation-assisted EMR) were performed according to tumor morphology (narrow-based and broad-based).The mean tumor size was 6.6 ± 3.9 mm and the mean procedure time was 11.0 ± 11.2 minutes. Most of the lesions (80.0%) were located in the duodenal 1st portion. Broad-based tumors were more common than narrow-based tumors (66.7% vs 33.3%). All broad-based tumors were resected successfully using ligation-assisted EMR. Although en-bloc resection and complete resection rates were higher in ligation-assisted EMR than in conventional EMR ([100% vs 87.5%], and [85.7% vs 62.5%], respectively), the difference was not significant (P = .333 and P = .310, respectively). Moreover, there was no evidence of local or distant metastasis during the follow-up (26.1 ± 20.7 months).Ligation-assisted EMR showed a higher complete resection rate than conventional EMR. Ligation-assisted EMR may be an optimal treatment option for duodenal carcinoid tumors with a broad base.

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Efficacy of Endoscopic Mucosal Resection for Management of Small Duodenal Neuroendocrine Tumors

Abstract: EMR for small duodenal NETs can be a safe and effective alternative to surgery in carefully selected patients. EUS is a useful adjunct in determining depth of invasion for duodenal NETs.

Cited by 23 publications

References 19 publications

S2k-Leitlinie Neuroendokrine Tumore

S2k-Leitlinie Neuroendokrine Tumore

Metachronous duodenal neuroendocrine neoplasms after endoscopic mucosal resection

Clinical outcomes of ligation-assisted endoscopic resection for duodenal neuroendocrine tumors

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