Effectiveness of Endoscopic Treatment for Gastrointestinal Neuroendocrine Tumors

Abstract

Several recent studies have explored efficacy and safety of different endoscopic treatments for gastrointestinal neuroendocrine tumors (GI-NETs). However, there is no definitive consensus regarding the best endoscopic approach for GI-NETs treatment. Therefore, the present study was conducted to investigate the application of various endoscopic techniques for the treatment of GI-NETs according to the previous conclusions and to summarize the optimal endoscopic modalities for GI-NETs.Ninety-eight patients with 100 GI-NETs removed by endoscopic therapies were reviewed. The pathological complete resection rate (PCRR), complication, local recurrence, and factors possibly associated with the pathological complete resection were analyzed.Twenty-two patients were treated by conventional polypectomy (including 6 cold biopsy forceps polypectomy and 16 snare polypectomy with electrocauterization), 41 by endoscopic mucosal resection (EMR), and 35 by endoscopic submucosal dissection (ESD). The PCRRs of conventional polypectomy, EMR, and ESD were 86.4%, 75.6%, and 85.7%, respectively. Sixteen GI-NETs that had a polypoid appearance, with a mean tumor size of 5.2 mm, were removed by snare polypectomy (PCRR 93.8%). The complication rates of conventional polypectomy, EMR, and ESD were 0.0% (0/22), 2.4% (1/41), and 2.9% (1/35), respectively. There were 2 local recurrences after cold biopsy forceps polypectomy treatment and no local recurrences in the EMR and ESD groups (P = 0.049). The results showed that PCRR was only associated with the depth of invasion (P = 0.038).Endoscopic resection of GI-NETs is safe and effective in properly selected patients. For submucosal GI-NETs, ESD was a feasible modality, with a higher PCRR compared with EMR. For ≤5 mm polypoid-like NETs, snare polypectomy with electrocauterization was a simple procedure with a high PCRR.

The NETest liquid biopsy is diagnostic for gastric neuroendocrine tumors: observations on the blood-based identification of microscopic and macroscopic residual disease

“…With the increasingly widespread use of endoscopy, GNENs are now diagnosed not only with rising frequency but also at an earlier age. In spite of their indolent behavior, an early diagnosis is important to facilitate the feasibility of curative resection [ 33 ]. It is also important for defining the biology of these lesions, and initiating monitoring as micronodules may grow or recur over time.…”

“…The clinical impact of this is not known yet [ 36 ]. Other features of a more aggressive potential have been attributed to grade, invasion beyond the mucosa layer, lymph node involvement or early recurrence after endoscopic polypectomy [ 33 , 37 ]. Given the inability to accurately define the propensity of a GNET to progress, a careful assessment of all GNETs is required to determine the most appropriate treatment.…”

Evaluating the ACS-NSQIP Risk Calculator in Primary GI Neuroendocrine Tumor: Results from the United States Neuroendocrine Tumor Study Group

“…Possible adverse events common to many types of GI surgery, and have also been implicated in GI-NET resection, include bowel bleeding and ischemia. 29,30 In addition, although endoscopic techniques have become increasingly popular because of their minimally invasive nature and faster recovery times, the complicated nature of these procedures has been associated with increased risk for perforation and delayed bleeding. 29,31,32 One possible contribution to increased risk for delayed bleeding and perforation may be anatomical tumor characteristics, including depth of invasion; however, few studies have evaluated patient risk factors which may contribute to this risk.…”

“…29,31,32 One possible contribution to increased risk for delayed bleeding and perforation may be anatomical tumor characteristics, including depth of invasion; however, few studies have evaluated patient risk factors which may contribute to this risk. 29,30,32 Future studies are needed to determine preoperative patient risk factors for developing these complications and how these risk factors can be used in conjunction with the ACS-NSQIP risk calculator in determining patient eligibility for endoscopic resection.…”

Therapeutic application of purse-string sutures with nylon loops and metal clips under single-channel endoscopy for repair of gastrointestinal wall defects

“…Endoscopic mucosal resection (EMR) and ESD techniques are now performed worldwide ( 9 ). Complications of these procedures include iatrogenic active perforation or unpredictable iatrogenic perforation ( 10 ).…”