Long-Term Follow-Up of Patients Undergoing Endoscopic Papillectomy for Papillary Neuroendocrine Tumor: A Case Series and Literature Review

Abstract

BACKGROUND: Duodenal papilla neuroendocrine tumors (DP-NET) are rare. Surgical therapy may be recommended for their treatment. However, they have high rates of morbidity and mortality. Endoscopic papillectomy (EP) is safe and effective for complete resection of tumors at this site. OBJECTIVE: This study aimed to describe a case series of DP-NETs resected by EP and perform a literature review. METHODS: A series of patients with DP-NETs underwent EP as primary treatment between Jan/2008 and Mar/2020 at a tertiary referral center. A comprehensive search was made on the MEDLINE primary electronic database. The search strategy was designed to find all articles related to DP-NETs published in the literature. RESULTS: Six patients underwent EP for presenting DP-NETs, four of whom were women (mean age, 63 years). The mean diameter of DP-NETs was 1.6±0.3 cm. Four of six patients were followed up, one of whom suffered relapse at the resection site after 3 months and was referred to surgery (pT3n1b) and the remaining three patients experienced no endoscopic or histological recurrence during follow-up periods of 10, 7, and 4 years, respectively. Eighteen articles were found in the literature search in MEDLINE. The articles included case reports of endoscopically treated DP-NETs. CONCLUSION: EP is safe and effective for DP-NETs that are ≤20 mm, confined to the submucosal layer, well-differentiated, and without local or remote metastasis. Adequate endoscopic follow-up and definitive surgical treatment in the presence of relapse are necessary.

Can Ampullary G1 and G2 Neuroendocrine Tumors Be Cured by Endoscopic Papillectomy?

“…Moreover, the results of the literature review further verified the satisfactory outcomes of endoscopic papillectomy for ampullary neuroendocrine tumors. Of note, the cases from our center consisted of larger-size tumors and more G2 cases than the cases already reported [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ].…”

“…Gincul et al [ 16 ] published a study focusing on the endoscopic treatment for small duodenal and ampullary neuroendocrine tumors, and in which seven cases with ampullary neuroendocrine tumors underwent endoscopic papillectomy; one case was lost follow-up; five cases achieved complete resection; and no recurrence occurred. Galetti et al [ 17 ] published a study in which endoscopic papillectomy was performed for three neuroendocrine tumors of major papilla, although the detailed follow-up information was not provided.…”