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

Abstract

Background and study aims Endoscopic resection of duodenal neuroendocrine tumors (DNETs) remains controversial, and its indications are still unclear. This study aimed to evaluate short-term outcomes of a newly developed endoscopic muscularis resection (EMR) method that utilizes an over-the-scope clip (OTSC), termed EMRO, for treating DNETs.

Patients and methods In total, 13 consecutive patients with 14 small (≤ 10 mm) DNETs who underwent EMRO from September 2017 to March 2020 were retrospectively enrolled. EMRO was performed by a single experienced endoscopist. Patients’ characteristics and treatment outcomes were assessed.

Results The En bloc and R0 resection rates were 100 % (14/14) and 92.9 % (13/14), respectively. The median pathological resected specimen size was 10 mm, with a median pathological resected tumor size of 6 mm. During the EMRO procedure, there was no occurrence of misplacement of the OTSC to the target lesion. With respect to the pathological resection depth, nine cases (64.3 %) and five cases (35.7 %) were categorized as deep submucosal resection and muscularis resection, respectively, whereas no case was categorized as full-thickness resection. There were no intraoperative or delayed perforations. However, delayed bleeding occurred in two cases. At a median follow-up of 12 months (range 7–36) after EMRO, there was no incidence of local recurrence. At the first follow-up endoscopy performed at 6 months after EMRO, the OTSC was retained in place in two of 14 DNETs (14.3 %).

Conclusions EMRO can be performed safely, by an experienced endoscopist, for small (≤ 10 mm) DNETs.

Publikationsverlauf

Eingereicht: 17. September 2020

Angenommen: 20. Januar 2021

Artikel online veröffentlicht:
22. April 2021

• References

• 1 Modlin IM, Lye KD, Kidd M. A 5-decade analysis of 13,715 carcinoid tumors. Cancer 2003; 97: 934-959
• 2 Yao JC, Hassan M, Phan A. et al. One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol 2008; 26: 3063-3072
• 3 Gincul R, Ponchon T, Napoleon B. et al. Endoscopic treatment of sporadic small duodenal and ampullary neuroendocrine tumors. Endoscopy 2016; 48: 979-986
• 4 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
• 5 Kim TW, Kim GH, Park DY. et al. Endoscopic resection for duodenal subepithelial tumors: a single-center experience. Surg Endosc 2017; 31: 1936-1946
• 6 Oono Y, Shinmura K, Hori K. et al. Endoscopic submucosal resection using a ligation device without injection for duodenal neuroendocrine tumors. Surg Endosc 2019; 33: 2008-2014
• 7 Fujimoto A, Sasaki M, Goto O. et al. Treatment results of endoscopic mucosal resection with a ligation device for duodenal neuroendocrine tumors. Intern Med 2019; 58: 773-777
• 8 Matsumoto S, Miyatani H, Yoshida Y. Endoscopic submucosal dissection for duodenal tumors: a single-center experience. Endoscopy 2013; 45: 136-137
• 9 Nishio M, Hirasawa K, Ozeki Y. et al. Short- and long-term outcomes of endoscopic submucosal dissection for non-ampullary duodenal neuroendocrine tumors. Ann Gastroenterol 2020; 33: 265-2671
• 10 Sato Y, Hashimoto S, Mizuno K. et al. Management of gastric and duodenal neuroendocrine tumors. World J Gastroenterol 2016; 22: 6817-6828
• 11 Kobara H, Mori H, Nishiyama N. et al. Over-the-scope clip system: A review of 1517 cases over 9 years. J Gastroenterol Hepatol 2019; 34: 22-30
• 12 Tashima T, Ohata K, Sakai E. et al. Efficacy of an over-the-scope clip for preventing adverse events after duodenal endoscopic submucosal dissection: a prospective interventional study. Endoscopy 2018; 50: 487-496
• 13 Dohi O, Yoshida N, Naito Y. et al. Efficacy and safety of endoscopic submucosal dissection using a scissors-type knife with prophylactic over-the-scope clip closure for superficial non-ampullary duodenal epithelial tumors. Dig Endosc 2020; 32: 904-913
• 14 Nagtegaal ID, Odze RD, Klimstra D. et al. The 2019 WHO classification of tumours of the digestive system. Histopathology 2020; 76: 182-188
• 15 Al-Bawardy B, Rajan E, Wong Kee Song LM. Over-the-scope clip-assisted endoscopic full-thickness resection of epithelial and subepithelial GI lesions. Gastrointest Endosc 2017; 85: 1087-1092
• 16 Sarker S, Gutierrez JP, Council L. et al. Over-the-scope clip-assisted method for resection of full-thickness submucosal lesions of the gastrointestinal tract. Endoscopy 2014; 46: 758-761
• 17 Kappelle WFW, Backes Y, Valk GD. et al. Endoscopic full-thickness resection of gastric and duodenal subepithelial lesions using a new, flat-based over-the-scope clip. Surg Endosc 2018; 32: 2839-2346
• 18 Kwon MJ, Kang HS, Soh JS. et al. Lymphovascular invasion in more than one-quarter of small rectal neuroendocrine tumors. World J Gastroenterol 2016; 22: 9400-9410
• 19 Bang BW, Park JS, Kim HK. et al. Endoscopic resection for small rectal neuroendocrine tumors: Comparison of endoscopic submucosal resection with band ligation and endoscopic submucosal dissection. Gastroenterol Res Pract 2016;
• 20 Tashima T, Nonaka K, Ryozawa S. Successful endoscopic en bloc full-thickness and complete resection for two adjacent rectal neuroendocrine tumors. Dig Endosc 2019; 31: 592
• 21 Schmidt A, Beyna T, Schumacher B. et al. Colonoscopic full-thickness resection using an over-the-scope device: a prospective multicentre study in various indications. Gut 2018; 67: 1280-1289
• 22 Rajan E, Wong Kee Song LM. Endoscopic full thickness resection. Gastroenterology 2018; 154: 1925-37.e2
• 23 Bauder M, Schmidt A, Caca K. Endoscopic full-thickness resection of duodenal lesions-a retrospective analysis of 20 FTRD cases. United European Gastroenterol J 2018; 6: 1015-1021
• 24 Brewer Gutierrez OI, Akshintala VS, Ichkhanian Y. et al. Endoscopic full-thickness resection using a clip non-exposed method for gastrointestinal tract lesions: a meta-analysis. Endosc Int Open 2020; 8: E313-E325
• 25 Kapadia S, Nagula S, Kumta NA. Argon plasma coagulation for successful fragmentation and removal of an over-the-scope clip. Dig Endosc 2017; 29: 820-821
• 26 Fähndrich M, Sandmann M, Heike M. Removal of over the scope clips (OTSC) with an Nd:YAG Laser. Z Gastroenterol 2011; 49: 579-583
• 27 Schmidt A, Riecken B, Damm M. et al. Endoscopic removal of over-the-scope clips using a novel cutting device: a retrospective case series. Endoscopy 2014; 46: 762-766
• 28 von Renteln D, Denzer UW, Schachschal G. et al. Endoscopic closure of GI fistulae by using an over-the-scope clip (with videos). Gastrointest Endosc 2010; 72: 1289-1296
• 29 Mumtaz S, Appannagari A, Gupta N. Two endoscopic resection methods for the removal of an over-the-scope clip. Gastrointest Endosc 2015; 82: 744
• 30 Krishna SG, Shakhatreh M. Endoscopic removal of over-the-scope clip with cold saline solution technique. Gastrointest Endosc 2016; 84: 850-851
• 31 Ou YH, Kong WF, Li LF. et al. Methods for endoscopic removal of over-the-scope clip: A systematic review. Can J Gastroenterol Hepatol 2020;
• 32 Tashima T, Nonaka K, Ryozawa S. Successful further endoscopic mucosal resection with an over-the-scope clip with circumferential mucosal incision for a residual rectal neuroendocrine tumor. Dig Endosc 2020; 32: 629