No histology for diminutive duodenal neuroendocrine tumors: Is it safe?

Abstract

For the management of diminutive duodenal neuroendocrine tumors (d-NETs), Harshit et al. have proposed – in the work accompanying this editorial – an interesting approach, the endoscopic banding without resection (BWR) technique. Given the risks associated with classic endoscopic resections and surgical procedures, and the likely favorable natural history of diminutive d-NETs, BWR may be an option for these selected patients with a very low risk of LN + and recurrence. However, a close follow-up (endoscopic, EUS and thoraco-abdominal CT scan) is then required to guarantee the safety of this policy.

• References

• 1 Delle Fave G, O’Toole D, Sundin A. et al. ENETS consensus guidelines update for gastroduodenal neuroendocrine neoplasms. Neuroendocrinology 2016; 103: 119-124
• 2 Fitzgerald TL, Dennis SO, Kachare SD. et al. Increasing incidence of duodenal neuroendocrine tumors: incidental discovery of indolent disease?. Surgery 2015; 158: 466-471
• 3 Kachare SD, Liner KR, Vohra NA. et al. A modified duodenal neuroendocrine tumor staging schema better defines the risk of lymph node metastasis and disease-free survival. Am Surg 2014; 80: 821-826
• 4 Dogeas E, Cameron JL, Wolfgang CL. et al. Duodenal and ampullary carcinoid tumors: size predicts necessity for lymphadenectomy. J Gastrointest Surg 2017; 21: 1262-1269
• 5 Gincul R, Ponchon T, Napoleon B. et al. Endoscopic treatment of sporadic small duodenal and ampullary neuroendocrine tumors. Endoscopy 2016; 48: 979-986
• 6 Kim GH, Kim JI, Jeon SW. et al. Endoscopic resection for duodenal carcinoid tumors: a multicenter, retrospective study. J Gastroenterol Hepatol 2014; 29: 318-324
• 7 Min BH, Kim ER, Lee JH. et al. Management strategy for small duodenal carcinoid tumors: does conservative management with close follow-up represent an alternative to endoscopic treatment?. Digestion 2013; 87: 247-253
• 8 Falconi M, Eriksson B, Kaltsas G. et al. ENETS consensus guidelines update for the management of patients with functional pancreatic neuroendocrine tumors and non-functional pancreatic neuroendocrine tumors. Neuroendocrinology 2016; 103: 153-171
• 9 Khara Harshit SG, Johal A, Diehl D. Endoscopic banding without resection (BWR) technique for treatment of diminutive neuroendocrine tumors in the duodenum. Endosc Int Open 2019; 07: E302-E307
• 10 Siyu S, Sheng W, Guoxin W. et al. Gastric perforations after ligation of GI stromal tumors in the gastric fundus. Gastrointest Endosc 2010; 72: 615-616
• 11 Matsumoto S, Miyatani H, Yoshida Y. et al. Duodenal carcinoid tumors: 5 cases treated by endoscopic submucosal dissection. Gastrointest Endosc 2011; 74: 1152-1156
• 12 Soga J. Endocrinocarcinomas (carcinoids and their variants) of the duodenum. An evaluation of 927 cases. J Exp Clin Cancer Res 2003; 22: 349-363
• 13 Farges O, Bendersky N, Truant S. et al. The theory and practice of pancreatic surgery in France. Ann Surg 2017; 266: 797-804