Comparisons of therapeutic outcomes in patients with nonampullary duodenal neuroendocrine tumors (NADNETs)

Lee, Seung Woo; Sung, Jae Kyu; Cho, Young Sin; Bang, Ki Bae; Kang, Sun Hyung; Kim, Ki Bae; Kim, Sae Hee; Moon, Hee Seok; Song, Kyung Ho; Kim, Sun Moon; Chung, Il‐Kwun; Lee, Dong Hoon; Jeong, Hyun Yong; Youn, Sei Jin

doi:10.1097/md.0000000000016154

Cited by 23 publications

(19 citation statements)

References 19 publications

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“…Immunohistochemistry is sensitive for detecting lymphovascular invasion and is recommended as an option in the ENETS guidelines 8 . In previous studies, the prevalence of lymphovascular invasion in nonampullary duodenal NETs treated with ER ranged from 0% to 10% 11,20,31–33 . There is a concern that the evaluation of lymphovascular invasion greatly differs depending on the presence of immunohistochemistry.…”

Section: Discussionmentioning

confidence: 99%

Favorable long‐term outcomes of endoscopic resection for nonampullary duodenal neuroendocrine tumor

Matsueda

Kanesaka

Kitamura

et al. 2021

J of Gastro and Hepatol

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Background and Aim The long‐term outcomes of endoscopic resection for nonampullary duodenal neuroendocrine tumors are limited. We aimed to clarify it. Methods Consecutive patients with nonampullary duodenal neuroendocrine tumors endoscopically treated at our institute between January 2005 and June 2020 were included in this retrospective study. En bloc and R0 resection rates and adverse events were evaluated as short‐term outcomes of endoscopic resection. The 5‐year overall and recurrence‐free survival rates of patients after endoscopic resection were calculated as long‐term outcomes. Results Of 34 patients with 34 lesions, 33 patients (97%) underwent endoscopic mucosal resection, and one (3%) underwent endoscopic submucosal dissection. En bloc resection was achieved in 33 lesions (97%). R0 resection was achieved in 20 lesions (59%). The median tumor size was 6 mm (range: 3–13). Thirty‐one lesions (91%) and three lesions (9%) were classified as G1 and G2, respectively. Lymphovascular invasion was observed in six lesions (18%). Intraprocedural perforation occurred in four patients (12%) who were conservatively treated with endoscopic closure. All 34 patients were followed up without additional treatment after endoscopic resection, and no recurrence or metastasis developed during the median follow‐up period of 47.9 months (range: 9.0–187.1). The 5‐year overall survival and recurrence‐free survival rates were 87.1% and 100%, respectively. Conclusions Endoscopic resection provided a favorable long‐term prognosis for patients with nonampullary duodenal neuroendocrine tumors without lymph node metastasis.

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Section: Discussionmentioning

confidence: 99%

Favorable long‐term outcomes of endoscopic resection for nonampullary duodenal neuroendocrine tumor

Matsueda

Kanesaka

Kitamura

et al. 2021

J of Gastro and Hepatol

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“…The main indication for ER in the duodenum is for nonampullary, < 20-mm nonfunctional duodenal NENs (d-NENs). Ampullary d-NENs and functional d-NENs exhibit a more aggressive etiology, with more synchronous lymph node and liver metastasis, and are therefore considered appropriate for oncological surgery [110][111][112]. G1 nonfunctional nonampullary d-NENs of < 20 mm have a much lower risk of metastasis, especially if smaller than 10 mm, and removal by local excision is therefore advised [89].…”

Section: Nensmentioning

confidence: 99%

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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“…While current guidelines recommend ER for non-ampullary D-NETs <10mm [2,24], for larger lesions it remains unclear whether a surgical or ER approach is superior [24]. Traditional ER methods, such as cold-snare polypectomy, EMR, Band-EMR and Band-EMR without resection (BWR) are limited by high rates of positive margins [6,11,[14][15][16][17][18][19][20][21]25]. One advantage of ESD over traditional ER techniques is that we were able to achieve 100% R0 horizontal margins.…”

Section: Discussionmentioning

confidence: 99%

Duodenal neuroendocrine tumors: Short-term outcomes of endoscopic submucosal dissection performed in the Western setting

Gupta,

Kumar,

Chacchi

et al. 2023

Endosc Int Open

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Background and Aims: Endoscopic resection (ER) is recommended for the management of duodenal neuroendocrine tumors (D-NETs) confined to the submucosal layer, without lymph node or distant metastasis. While this is accepted practice for lesions <10mm, consensus for larger lesions remains unclear. Although endoscopic submucosal dissection (ESD) has been proposed as the preferred ER technique for DNETs ≥10mm, there is limited data on efficacy and safety, particularly in the Western setting. Methods: We performed a retrospective analysis of patients with D-NETs who underwent ESD between 2012 and 2022 in three tertiary referral centers in Australia, France and Belgium. Results: Fourteen patients with 15 D-NETs were evaluated. Median patient age was 64 years (IQR 58-70 years). All D-NETs were confined to duodenal bulb. Median D-NET size was 10mm (IQR 7-12mm) and specimen size was 15mm (IQR 15-20mm). Median procedure time was 60 minutes (IQR 25-90 minutes). The rate of enbloc resection was 100%. Intra-procedural perforation occurred in 4 (26.7%), with all closed endoscopically without long-term sequelae. There were no episodes of clinically significant bleeding. No local recurrence, lymph node or distant metastasis was observed at a median follow-up of 19.9 months (IQR 10.3-49.3 months). Conclusions: In experienced hands, ESD for D-NETs can achieve a 100% enbloc resection rate. There were no cases of local recurrence or distant metastatic spread, indicating that ESD may be a viable option for patients with D-NETs 10-15 mm that are not surgical candidates.

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Comparisons of therapeutic outcomes in patients with nonampullary duodenal neuroendocrine tumors (NADNETs)

Cited by 23 publications

References 19 publications

Favorable long‐term outcomes of endoscopic resection for nonampullary duodenal neuroendocrine tumor

Favorable long‐term outcomes of endoscopic resection for nonampullary duodenal neuroendocrine tumor

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

Duodenal neuroendocrine tumors: Short-term outcomes of endoscopic submucosal dissection performed in the Western setting

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