Endoscopic Mucosal Resection in the Management of Gastric Carcinoid Tumors

Ichikawa, Junko; Tanabe, Soichi; Koizumi, Wasaburou; Kida, Youhei; Inoue, Hiroshi; Kida, Mitsushiro; Saigenji, Katsunori; Mitomi, Hiroyuki

doi:10.1055/s-2003-37256

Cited by 109 publications

(73 citation statements)

References 6 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%

See 1 more Smart Citation

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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“…Dado que la gran mayoría corresponden a carcinoides tipo I de buen pronóstico, una resección mucosa endoscópica es capaz de controlar la enfermedad, sin embargo, algunos de estos casos no son susceptibles de este abordaje. Se ha propuesto que lesiones > 1 cm o > 3-5 en número deben ir a cirugía 10 , indicación que varía según el centro ya que mientras en Japón toda lesión > 1 cm va a cirugía, en Europa la indicación parte de 2 cm y según la existencia o no de factores de riesgo de metástasis 6 . Cuando hablamos de cirugía nos referimos a una gastrectomía total, ya que estas lesiones son proximales y hoy se sabe que en el carcinoide tipo I la enfermedad compromete a toda la mucosa y no a un sector de esta, muchas veces asociado a microcarcinoides concomitantes y lesiones displá-sicas dispersas no evidenciables en la endoscopía, concepto conocido como microcarcinoidosis 1 .…”

Section: Discussionunclassified

Gastrectomía laparoscópica en carcinoide gástrico

et al. 2013

Rev Chil Cir

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Laparoscopic gastrectomy in gastric carcinoidIntroduction: Gastric carcinoid is a very low frequency tumor. A proportion of them require surgery to control the disease. The ideal surgical treatment is controversial. Aim: To describe the perioperative and follow-up course of patients with gastric carcinoid subjected to laparoscopic gastrectomy. Materials and Methods: Retrospective study of patients undergoing some type of laparoscopic gastrectomy for gastric carcinoid the last 10 years. We collected demographic background, preoperative evaluation, type of surgery, complications and follow-up. Results: During the study period were operated 7 patients, 5 were men. The average age was 54 years. In three patients the diagnosis was a finding, while the rest had abdominal pain associated with nonspecific symptoms. Four patients had a type I gastric carcinoid associated with chronic gastritis and hypergastrinemia, and the others had a type III gastric carcinoid. Six patients underwent laparoscopic total gastrectomy while in the remaining patient (type III) was subtotal. There were no postoperative complications. During follow-up one patient required a reoperation for mechanical ileus secondary to adhesions and one patient required endoscopic dilatation because esophagoyeyunostomy stenosis. At 32 months of median follow-up (1-52) no patient has relapsed. Conclusion: Laparoscopic gastrectomy is an alternative in the surgical treatment of patients with gastric carcinoid. It´s safe and represent adequate oncological results in the short and medium term.

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“…In type I gastric carcinoid tumors with chronic atrophic gastritis and hypergastrinemia, EMR can be initial treatment of choice if the tumors are smaller than 1 cm and not extending beyond the submucosa and are fewer than five in number. 2,3,13 After EMR, the patients should be performed endoscopy regularly every 6 to 12 months. If recurrence is seen, wide surgical resection such as partial gastrectomy, antrectomy or total gastrectomy can be performed, depending on the extention of the disease.…”

Section: Discussionmentioning

confidence: 99%

Gastric Carcinoid Tumors: The Problems Encountered in Diagnosis and Treatment

Yüksel¹

2013

UHOD

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Gastric carcinoid tumors are rare tumors that originate from gastric enterochromaffin-like cells in the oxyntic mucosa and constitute 3.2-4% of all carcinoid tumors. Herein, outcome of a single institution experience with gastric carcinoid tumors were evaluated retrospectively. The patients with gastric carcinoid tumors were analyzed with respect to their presenting signs and symptoms, serum gastrin level, imaging studies, operative procedures and outcome of 21 patients with gastric carcinoid tumor were enrolled in this study. Sixteen patients had type 1 and 5 had type IV gastric carcinoid tumors. Endoscopic biopsy was performed in 15 patients with type I and in 2 patients with type IV. Multifocal tumor was seen in 7 patients with type I. Preoperative serum gastrin levels were high in 11 patients with type I and 3 patients with type IV gastric carcinoid tumor. In the patients with type I gastric carcinoid tumor, endoscopic mucosal resection (EMR) was performed in 6 patients with only one tumor and the tumor size less than 1 cm. In this group, 3 patients had relapse (50%). Total gastrectomy was performed in all the patients with type IV gastric carcinoid tumor. The 5-year survival of type I and IV gastric carcinoid tumors were 69.1% and 48.6%, respectively.

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Endoscopic Mucosal Resection in the Management of Gastric Carcinoid Tumors

Abstract: EMR is useful in the management of type 1 gastric carcinoids as classified by Rindi (hypergastrinemia; tumor diameter of 10 mm or less).

Cited by 109 publications

References 6 publications

Endoscopic submucosal dissection for foregut neuroendocrine tumors: An initial study

Endoscopic submucosal dissection for foregut neuroendocrine tumors: An initial study

Gastrectomía laparoscópica en carcinoide gástrico

Gastric Carcinoid Tumors: The Problems Encountered in Diagnosis and Treatment

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