Management of Duodenal Neuroendocrine Tumors: Surgical versus Endoscopic Mucosal Resection

Tran, Catherine; Sherman, Scott K.; Suraju, Mohammed O.; Nayyar, Apoorve; Gerke, Henning; Abiad, Rami El; Chandrasekharan, Chandrikha; Ear, Po Hien; O’Dorisio, Thomas M.; Dillon, Joseph S.; Bellizzi, Andrew M.; Howe, James R.

doi:10.1245/s10434-021-10774-9

Cited by 14 publications

(13 citation statements)

References 33 publications

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“…Most duodenal NET <2 cm do not have nodal metastases and may be resected endoscopically. 12 In this case, known nodal metastases precluded endoscopic resection. Moreover, the primary tumor was not definitively identified until laparotomy.…”

Section: Discussionmentioning

confidence: 88%

Recurrent Gastrointestinal Pseudo-obstruction Because of Well-Differentiated Duodenal Neuroendocrine Tumor

et al. 2022

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A 56-year-old man presented with recurrent gastrointestinal obstruction. Computed tomography showed fluid-filled, distended stomach, small intestine, and large intestine. Extensive workup including esophagogastroduodenoscopy, colonoscopy, magnetic resonance enterography, push enteroscopy, and video capsule enteroscopy showed no mechanical obstruction. Endoscopic ultrasound-guided biopsy of peripancreatic nodes detected on 18 F-fluorodeoxyglucose positron emission tomography revealed a duodenal neuroendocrine tumor. The lesion showed intense uptake on gallium-68 DOTATOC positron emission tomographycomputed tomography scan. The patient underwent surgical resection of the tumor with resolution of bowel obstruction events. He had elevated pancreatic polypeptide levels, which are known to delay gastric emptying and could explain his symptoms.Previous computed tomography (CT) scans of the abdomen showed variable distension of the stomach, or fluid-filled small intestine with concern for transition point at the ileum, or distended large intestine. He had formerly undergone 2 esophagogastroduodenoscopies, which did not reveal gastric outlet obstruction. His current CT abdomen showed a fluid-filled stomach and duodenum, suggestive of gastric outlet obstruction (Figure 1). Magnetic resonance enterography (MRE) did not show obstruction, but demonstrated a 2.1 3 2.3-cm right mesenteric nodule with similar enhancement as the spleen, raising the possibility of ectopic splenic tissue, and a 0.7-cm nodule posterior to the uncinate process.Push enteroscopy revealed esophagitis and severe aphthous ulcerations in the small intestine, but no obstruction. Colonoscopy did not reveal any obstructive pathology. Video capsule enterography revealed erythematous mucosa with villous blunting and nonobstructive luminal narrowing in the duodenum through which the capsule passed easily.An 18 F-fluorodeoxyglucose positron emission tomography ( 18 FDG PET)/CT scan was performed to further evaluate the mesenteric lesion seen on MRE. It showed multiple mild to moderately FDG avid cervical lymph nodes (LN), the largest a 4-cm left supraclavicular LN. It redemonstrated the soft-tissue lesion anterior to the duodenum with mild to moderate FDG uptake and multiple

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Section: Discussionmentioning

confidence: 88%

Recurrent Gastrointestinal Pseudo-obstruction Because of Well-Differentiated Duodenal Neuroendocrine Tumor

et al. 2022

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“…For the purpose of our systematic review, seven studies [ 5 , 12 , 13 , 14 , 15 , 16 , 17 ], met the inclusion criteria and contained relevant data on dNENs sized between 10 mm and 20 mm. The other studies were discarded due to insufficient data.…”

Section: Resultsmentioning

confidence: 99%

“…The included studies were all retrospective ( Table 1 ). According to the Newcastle-Ottawa Scale (NOS) for cohort studies, six studies were categorized as moderate quality [ 5 , 14 , 15 , 16 , 17 , 18 ] and one study only as high quality, with a score of 7/9 [ 13 ]. Information regarding the histologic grading was available for only 29 dNENs undergoing endoscopic resection: 21 tumors (72.5%) were grade 1 (G1), 8 (27.5%) were grade 2 (G2), and none were classified as grade 3 (G3).…”

Section: Resultsmentioning

confidence: 99%

Endoscopic Resection for Duodenal Neuroendocrine Neoplasms between 10 and 20 mm—A Systematic Review and Meta-Analysis

Rossi,

Masoni,

Massironi

et al. 2024

JCM

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Background. The optimal management of duodenal neuroendocrine neoplasms (dNENs) sized 10–20 mm remains controversial and although endoscopic resection is increasingly performed instead of surgery, the therapeutic approach in this setting is not fully standardized. We performed a systematic review of the literature and a meta-analysis to clarify the outcomes of endoscopic resection for 10–20 mm dNENs in terms of efficacy (i.e., recurrence rate) and safety. Methods. A computerized literature search was performed using relevant keywords to identify pertinent articles published until January 2023. Results. Seven retrospective studies were included in this systematic review. The overall recurrence rate was 14.6% (95%CI 5.4–27.4) in 65 patients analyzed, without significant heterogeneity. When considering studies specifically focused on endoscopic mucosal resection, the recurrence rate was 20.5% (95%CI 10.7–32.4), without significant heterogeneity. The ability to obtain the free margin after endoscopic resection ranged between 36% and 100%. No complications were observed in the four studies reporting this information. Conclusions. Endoscopic resection could be the first treatment option in patients with dNENs sized 10–20 mm and without evidence of metastatic disease. Further studies are needed to draw more solid conclusions, particularly in terms of superiority among the available endoscopic techniques.

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“…Tumoren > 1, aber < 2 cm ohne weitere Risikokonstellation sollten in einer individuellen Nutzen-Risiko-Abwägung angegangen werden. Die technische Machbarkeit einer endoskopischen Resektionstherapie mittels EMR ist in vielen Fällen gegeben [29]. Eine evtl.…”

Section: Duodenum-netunclassified

Spannungsfeld endoskopische Resektionsverfahren bei GEP-NET // Endoscopic resection for GEP-NET

et al. 2022

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ZusammenfassungNeuroendokrine Tumoren des Verdauungstraktes (GEP-NET) sind eine seltene Tumorentität, die häufig als Zufallsbefund diagnostiziert werden. Ein großer Teil dieser Zufallsdiagnosen wird im Rahmen einer endoskopischen Untersuchung gestellt. Während die vollständige Entfernung des Tumors im Sinne einer kurativen chirurgischen Resektion nach onkologischen Kriterien das Standardvorgehen für lokalisierte Tumorerkrankungen ist, kann bei kleinen Tumoren ohne Hinweis und Risiko für eine lymphogene Metastasierung eine endoskopische Abtragung in gleicher Intention erfolgen. Während dies für Magen-, Duodenum- und Rektum-NET der Standard ist, sollten NET des Jejunums und Ileums aufgrund der hohen Metastasierungsrate trotz geringer Tumorgröße regelhaft nicht endoskopisch angegangen werden. Die Grenze für eine endoskopische Resektion ergibt sich sowohl durch die technische Machbarkeit im Sinne des Erreichens einer R0-Resektion, der erwarteten Komplikationen im Sinne von Blutung und Perforationen als auch durch das vermutete Risiko für eine lymphogene Metastasierung. Generell wird eine endoskopische Resektion bei Befunden < 1 cm regelhaft empfohlen, da sowohl die gute technische Machbarkeit als auch das geringe Metastasierungsrisiko für eine endoskopische Resektion sprechen. Bei allen Befunden über 2 cm Größe sind sowohl die technischen Erfolgsaussichten so niedrig als auch das Metastasierungsrisiko so hoch, dass in dieser Situation regelhaft ein chirurgisches Vorgehen erfolgen sollte. Es bleibt somit ein Graubereich bei der Tumorgröße zwischen 1 und 2 cm, wo sowohl endoskopische, aber auch chirurgische Resektionsverfahren sinnvoll eingesetzt werden können. Zunehmend kommen auch gemeinsame Eingriffe im Sinne eines endoskopisch-laparoskopischen Rendezvous-Verfahrens zum Einsatz – insbesondere im Duodenum bieten sich diese Eingriffe an, um eine minimale Resektion mit größtmöglicher R0-Erfolgsrate und niedriger Perforationsrate zu erreichen.

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Management of Duodenal Neuroendocrine Tumors: Surgical versus Endoscopic Mucosal Resection

Cited by 14 publications

References 33 publications

Recurrent Gastrointestinal Pseudo-obstruction Because of Well-Differentiated Duodenal Neuroendocrine Tumor

Recurrent Gastrointestinal Pseudo-obstruction Because of Well-Differentiated Duodenal Neuroendocrine Tumor

Endoscopic Resection for Duodenal Neuroendocrine Neoplasms between 10 and 20 mm—A Systematic Review and Meta-Analysis

Spannungsfeld endoskopische Resektionsverfahren bei GEP-NET // Endoscopic resection for GEP-NET

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