Long-term follow up of patients with multiple gastric carcinoids associated with type A gastritis

Abstract

Little is known about the natural course of multiple gastric carcinoids associated with type A gastritis. Between 1993 and 2003, we enrolled eight patients, diagnosed as having multiple gastric carcinoids associated with type A gastritis, in a followup program without surgical resection. In these patients, endoscopy showed multiple small polyps on the gastric body, with nonantral atrophic gastritis. Histologically, biopsy specimens obtained from the polyps revealed carcinoid tumors. The serum gastrin level was found to be very high in all patients, and testing for anti-parietal cell antibody was positive in seven. The mean follow-up was 5.8 years (range, 1.5-10.8 years). The levels of serum gastrin increased in all patients, but, endoscopically, the carcinoid tumors did not change in size. Neither hepatic nor lymphatic metastasis was detected on abdominal computed tomography (CT). These patients were free of the development or metastasis of carcinoids, in spite of their continuous hypergastrinemia. It was concluded that multiple gastric carcinoids associated with type A gastritis may be indolent.

Gastric endocrine tumors type I: treatment with long-acting somatostatin analogs

“…More recently, some reports have suggested that a careful endoscopic follow-up without any treatment might represent a reasonable and safe option in selected patients (Rappel et al 1995, Hori et al 2000, Ruszniewski et al 2006, Ravizza et al 2007. In a recent study, Hosokawa et al (2005) enrolled eight patients with multiple gastric endocrine tumors associated with type A gastritis in a follow-up program without surgical resection. These patients were free from the development or metastasis of carcinoids after a mean follow-up of 5.8 years in spite of their continuous hypergastrinemia, and the authors concluded that patients with multiple type I gastric endocrine tumors should not undergo surgical resection, but should instead be followed-up endoscopically.…”

“…They are almost exclusively benign lesions with little risk of deep invasion of the gastric parietal wall (Rindi et al 1999). These tumors have a good prognosis, with a 5-year survival rate quoted at 96%, which does not differ from an age-matched normal population (Borch et al 2005, Hosokawa et al 2005.…”

Somatostatin analogs for gastric carcinoids: For many, but not all

“…The European Neuroendocrine Tumor Society (ENETS) Consensus Guidelines have suggested that annual surveillance is sufficient in case of GC1s with a diameter < 10 mm ø [8] . This approach is supported by some reports [24,[38][39][40] which suggest that careful endoscopic follow-up might represent a reasonable safe option in selected patients. However, further studies evaluating larger cohorts during a longer follow-up period are necessary in order to support this clinical behavior, as some cases of progressive malignant GC1s have already been reported [17][18][19]41] .…”

Review: Screening, Diagnosis and Management of Gastric Carcinoid

“…Conservative management in the form of endoscopic surveillance with, or without, resection is the widely exercised and favored treatment modality of type 1 GCs [8,29,36,37]. However, a comprehensive literature review shows scant supporting, evidence-based data that is lacking in statistical power.…”

“…Although these lesions are typically benign and treated with conservative management and surveillance, one can argue that patients with gastric carcinoid secondary to chronic atrophic gastritis remain at risk for development of adenocarcinoma, with conversion rate of up to 10% per year; therefore, warranting resection of any and all polyps [36,37,40].…”