Short- and long-term outcomes of endoscopic submucosal dissection for non-ampullary duodenal neuroendocrine tumors

Abstract

Background Endoscopic resection is recommended for non-ampullary duodenal neuroendocrine tumors (NAD-NETs) ≤10 mm in diameter and confined to the submucosal layer, without lymph node or distant metastasis. However, the efficacy and safety of endoscopic submucosal dissection (ESD) for NAD-NET remains unclear. The aim of this study was to assess the short-term efficacy and safety and the long-term outcomes of ESD for NAD-NET.Methods Eight patients with 8 NAD-NETs who underwent ESD between 2015 and 2018 were included. The indications for ESD were: i) tumor ≤10 mm in diameter; ii) NET G1; iii) confined to the submucosal layer; and iv) without lymph node or distant metastasis. We retrospectively assessed the short-and long-term outcomes and safety. ResultsThe median patient age was 69 (48-76) years. All tumors were located in the duodenal bulb and showed 0-Is morphology. The median size was 6.4 (3-9.3) mm. The rates of en bloc resection, histologically free horizontal and vertical margins, and curative resection were 100%, 88%, and 88%, respectively. Intraoperative and postoperative perforation each occurred in 13% of patients, all of whom were treated conservatively and avoided emergent surgery. Delayed bleeding was not observed. No local, lymph node or distant recurrence was observed during a median follow-up period of 34 (18.5-62.5) months. ConclusionsThe rates of en bloc and curative resection, and histologically free margins were sufficiently high. Although intraoperative and postoperative perforations occurred, emergency surgery was not needed. The results show that ESD is an efficacious and safe treatment for NAD-NET.

Endoscopic resection using an over-the-scope clip for duodenal neuroendocrine tumors

“…5). However, the delayed bleeding rate in our study was higher than the previously reported rates for ESMR-L [5][6][7] and ESD [4,8,9]. Therefore, when performing prophylactic endoscopic coagulation of a mucosal defect to the fullest extent possible, even without bleeding immediately after resection, it is recommended that surgeons always perform a second endoscopy on the next day after EMRO.…”

“…Among the several endoscopic resections for DNETs reported, ESMR-L [5][6][7] and ESD [4,8,9] are the mainly used standard methods. In general, ESMR-L is considered technically easy, safe, and inexpensive.…”

“…However, perforation has even been reported in patients treated with ESMR-L [7]. Furthermore, ESD for DNETs takes more time [4,9] and is challenging because of the high risk of perforation [9]. When comparing EMRO to the above duodenal endoscopic resection techniques in terms of R0 resection rate and AEs, the R0 resection rate was 92.9 % and the intraoperative or delayed perforation rate was 0 %, suggesting that EMRO considerably reduces intraoperative and delayed perforation risks while achieving relatively higher R0 resection rates.…”

“…Endoscopic resection of DNETs remains controversial and its indications unclear. Endoscopic mucosal resection (EMR) [3,4], cap-assisted endoscopic mucosal resec-tion (EMR-C) [3], endoscopic submucosal resection with ligation (ESMR-L) [5][6][7], and endoscopic submucosal dissection (ESD) [4,8,9] are deemed suitable for the resection of small DNETS (≤ 10 mm) with a low malignancy potential. DNETs develop from the deep mucosa and are histologically classified as epithelial tumors and macroscopically as submucosal tumors [10].…”

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

“…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.…”