Endoscopic resection of small duodenal carcinoid tumors with strip biopsy technique

Yoshikane, Hiroaki; Goto, Hidemi; Niwa, Yasumasa; Matsui, M.; Ohashi, Shinji; Suzuki, Takashi; Hamajima, Eiji; Hayakawa, Tetsuo

doi:10.1016/s0016-5107(98)70246-9

Cited by 35 publications

(26 citation statements)

References 10 publications

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“…This approach offers the promise of localized treatment of these tumors with relatively few complications and low mortality. Various endoscopic resection procedures have been described as potential treatment procedures for foregut NETs, such as endoscopic polypectomy, strip biopsy, aspiration resection, and band-snare resection [5][6][7][8][9][10][11][12] . However, complete resection of NETs is difficult with conventional polypectomy because most gastrointestinal NETs are not confined to the mucosa but, rather, invade the submucosa [13] , which results in frequent involvement of the resection margin.…”

Section: Discussionmentioning

confidence: 99%

“…Foregut NETs that are limited to the mucosa/submucosa and are less than 11-20 mm in size demonstrate a low frequency of lymph node and distant metastasis, and thus have been managed with local excision (including endoscopic treatment), which offers improved quality of life compared with surgery [3,4] . Nowadays traditional polypectomy and endoscopic mucosal resection (EMR) are most commonly employed for some foregut NETs [5][6][7][8][9][10][11][12] . However, complete histological resection may not always be easy to achieve by using EMR because most gastrointestinal NETs are not confined to the mucosa but, rather, invade the submucosa [13] , which results in frequent involvement of the resection margin.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic submucosal dissection for foregut neuroendocrine tumors: An initial study

Zhang²,

Chen³

et al. 2012

WJG

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AIM:To evaluate the feasibility and efficacy of endoscopic submucosal dissection (ESD) for foregut neuroendocrine tumors (NETs). METHODS:From April 2008 to December 2010, patients with confirmed histological diagnosis of foregut NETs were included. None had regional lymph node enlargement or distant metastases to the liver or lung on preoperative computerized tomography scanning or endoscopic ultrasonography (EUS). ESD was attempted under general anesthesia. After making several marking dots around the lesion, a mixture solution was injected into the submucosa. The mucosa was incised outside the marking dots. Dissection of the submucosal layer beneath the tumor was performed under direct vision to achieve complete en bloc resection of the specimen. Tumor features, clinicopathological characteristics, complete resection rate, and complications were evaluated. Foregut NETs were graded as G1, G2, or G3 on the basis of proliferative activity by mitotic count or Ki-67 index. All patients underwent regular follow-up to evaluate for any local recurrence or distant metastasis. RESULTS:Those treated by ESD included 24 patients with 29 foregut NETs. The locations of the 29 lesions are as follows: esophagus (n = 1), cardia (n = 1), stomach (n = 23), and duodenal bulb (n = 4). All lesions were found incidentally during routine upper gastrointestinal endoscopy for other indications, and none had symptoms of carcinoid syndrome. Preoperative EUS showed that all tumors were confined to the submucosa. Among the 24 gastric lesions, 16 lesions in 11 patients were type I gastric NETs arising in chronic atrophic gastritis with hypergastrinemia, while the other 8 solitary lesions were type Ⅲ because of absence of atrophic gastritis in these cases. All of the tumors were removed in an en bloc fashion. The average maximum diameter of the lesions was 9.4 mm (range: 2-30 mm), and the procedure time was 20.3 min (range: 10-45 min). According to the World Health Organization 2010 classification, histological evaluation determined that 26 lesions were NET-G1, 2 gastric lesions were NET-G2, and 1 esophageal lesion was neuroendocrine carcinoma (NEC). Complete resection was achieved in 28 lesions (28/29, 96.6%), and all of them were confined to the submucosa in histopathologic assessment with no lymphovascular invasion. The remaining patient with NEC underwent additional surgery because the resected specimens revealed angiolymphatic and muscularis invasion, as well as incomplete Li QL et al . ESD for foregut NETs 5800October 28, 2012|Volume 18|Issue 40| WJG|www.wjgnet.com resection. Delayed bleeding occurred in 1 case 3 d after ESD, which was managed by endoscopic treatment. There were no procedure-related perforations. During a mean follow-up period of 24.4 mo (range: 12-48 mo), local recurrence occurred in only 1 patient 7 mo after initial ESD. This patient successfully underwent repeat ESD. Metastasis to lymph nodes or distal organs was not observed in any patient. No patients died during the study period.CONCLUSION: ESD appears to...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Endoscopic submucosal dissection for foregut neuroendocrine tumors: An initial study

Zhang²,

Chen³

et al. 2012

WJG

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“…Duodenal CTs are usually small, less than 1 cm in size (our cases were equal to or smaller than 5 mm) and located in the bulb (20). In the most extensive series (21) with 24 cases, 89% were smaller than 2 cm, and 85% were confined to the mucosa and submucosa, with a survival rate of 100% at nearly 4 years.…”

Section: Discussionmentioning

confidence: 85%

Gastrointestinal carcinoid tumors

Varas-Lorenzo¹,

Muñoz-Agel²,

Espinós-Pérez³

et al. 2010

Rev. esp. enferm. dig.

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Carcinoid tumors (CTs) were described more than 100 years ago by Oberndorfer (1,2). MacDonald (1) found 0.02% carcinoids in surgical cases, and 1% in necropsies.The incidence of carcinoid tumors has increased over time from 0.32/100,000 population and year (3) in the only community-based study available to 1-2 cases/100,000/year (4,5), and then further to 4.4/ 100,000/year (6,7); the rate in surgical specimens and necropsies was 8.4/100,000/year in Sweden during a 12-year period of time (8). The one study in our country (9) points out an incidence of 0.7/100,000 population/year for all CTs (0.125% in necropsies).CTs occur twice as much in Afro-American than in Caucasian patients (10). Gender distribution is similar, REV ESP ENFERM DIG (Madrid) Vol. 102. N.°9, pp. 533-537, 2010 Received: 29-10-09. Accepted: 25-02-10.Correspondence: M. J. Varas Lorenzo. Centro Médico Teknon. C/ Marquesa de Vilallonga, 12. 08017 Barcelona. Spain. e-mail: varas@dr.teknon.es Varas-Lorenzo MJ, Muñoz-Agel F, Espinós-Pérez JC, Bardají-Bofill M. Gastrointestinal carcinoid tumors. Rev Esp Enferm Dig 2010; 102: 533-537. ORIGINAL PAPERS ABSTRACTObjective: carcinoid tumors (CTs) represent the commonest neuroendocrine tumors.Those in the gastrointestinal tract are diagnosed in surgical specimens, clinically, and using imaging techniques (endoscopy, echoendoscopy, CT, Octreoscan, etc.).The goal of this retrospective study was to review a personal series of gastrointestinal carcinoid tumors, and to compare it to those in the literature.Patients and methods: the medical records of 40 Caucasian patients with over 50 gastrointestinal carcinoid tumors (including multiple cases) who were seen for a period of 16 years (1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009) were reviewed.Results: mean age at presentation was 52 years, 50% were females, and mean tumor size was 9.9 mm. Most were gastroduodenal (42.5%) or rectal (30%), and were treated endoscopically. Metastases and carcinoid syndrome (CS) were seen in 5% of patients. Survival at study endpoint was 85%.Conclusions: age and gender were consistent with the literature. There was an increase in gastroduodenal (multifocal) and rectal carcinoids, likely because the series was essentially endoscopical in nature (bias). There was a lower rate of CS and higher survival, likely due to earlier diagnosis and treatment.Key words: Gastrointestinal carcinoid tumors. Neuroendocrine tumors. Carcinoid syndrome. RESUMENObjetivo: los tumores carcinoides (TC) son los tumores neuroendocrinos más frecuentes. Los digestivos se diagnostican en las piezas quirúrgicas, en la clínica, y mediante los métodos de imagen (endoscopia, ecoendoscopia, TAC y Octreoscan, etc.).El objetivo de este trabajo retrospectivo fue revisar una serie personal de tumores carcinoides digestivos y compararla con la literatura.Pacientes y métodos: se revisaron las historias clínicas de 40 pacientes de raza blanca con más de 50 tumores carcinoides digestivos, algunos múltiples, observados du...

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“…3,[5][6][7] Due to its metastatic potential, it is imperative to perform EUS before deciding on the therapeutic strategy, appropriate case selection is important before planning endoscopic removal for duodenal carcinoids. [3][4][5][6][7] Endoscopic treatment, such as EMR or EMD has been used sporadically as an alternative to conventional surgery. These techniques have their own spectrum of complications, the more sinister of them being perforation.…”

Section: 2mentioning

confidence: 99%

“…1,3,4 Recently, endoscopic treatment such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (EMD) has been attempted as an alternative to conventional surgery. [3][4][5][6][7] The aim of this report is to explore the possibility of endoscopic banding and resection of small duodenal carcinoids, thereby avoiding the morbidity associated with conventional foregut surgery. This report to our knowledge is the only the second such report of endoscopic banding for duodenal carcinoids in English medical literature.…”

Section: Introductionmentioning

confidence: 99%