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DOI: 10.1055/a-1487-5594
Comparison of endoscopic resection techniques for duodenal neuroendocrine tumors: systematic review
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Abstract
Background and study aims Regardless of size, duodenal neuroendocrine tumors (dNETs) should be considered potentially malignant. A complete resection without complications is essential to increase safety procedures. The aim of this review was to describe effectiveness and possible complications of endoscopic techniques resection for resectioning dNETs in patients with tumors ≤ 20 mm in diameter.
Methods An electronic bibliographic search was conducted using MEDLINE (via PubMed), Embase, Cochrane Central, and Google Scholar virtual databases. The types of intervention were endoscopic mucosal resection alone (EMR) or with cap (EMR-C), with a ligation device (EMR-L), with previous elevation of the tumor (EMR-I) or with endoscopic submucosal dissection (ESD); argon plasm coagulation (APC), and polypectomy. The outcome measures adopted were presence of free margin associated with tumor resection, tumor recurrence, complications (bleeding and perforation), and length of the procedure.
Results Ten publications were included with the result of 224 dNET resections. EMR alone and polypectomy resulted in the most significantly compromised margin. The most frequent complication was bleeding (n = 21), followed by perforation (n = 8). Recurrence occurred in 13 cases, the majority of those under EMR or EMR-I.
Conclusions EMR-C or EMR-I should be preferred for resectioning of dNETs. Polypectomy should not be indicated for resection of dNETs due to the high occurrence of incomplete resections. EMR alone must be avoided due a higher frequency of compromised margin and recurrent surgery. ESD was associated with no recurrence, however, but an increased occurrence of bleeding and perforation.
Publication History
Received: 14 September 2020
Accepted: 29 March 2021
Article published online:
16 July 2021
© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Ochiai Y, Kato M, Kiguchi Y. et al. Current Status and challenges of endoscopic treatments for duodenal tumors. Digestion 2019; 99: 21-26
- 2 Burke AP, Sobin LH, Federspiel BH. et al. Carcinoid tumors of the duodenum. A clinicopathologic study of 99 cases. Arch Pathol Lab Med 1990; 114: 700-704
- 3 Gaspar JP. Approach to the endoscopic resection of duodenal lesions. World J Gastroenterol 2016; 22: 600
- 4 Sato Y, Hashimoto S, Mizuno K. et al. Management of gastric and duodenal neuroendocrine tumors. World J Gastroenterol 2016; 22: 6817
- 5 Scherübl H, Cadiot G. Early Gastroenteropancreatic Neuroendocrine tumors: endoscopic therapy and surveillance. Visc Med 2017; 33: 332-338
- 6 Waisberg J, Joppert-Netto G, Vasconcellos C. et al. Carcinoid tumor of the duodenum. Arq Gastroenterol 2013; 50: 3-9
- 7 Waisberg DR, Fava AS, Martins LC. et al. Colonic carcinoid tumors: a clinicopathologic study of 23 patients from a single institution. Arq Gastroenterol 2009; 46: 288-293
- 8 Tsujimoto H, Ichikura T, Nagao S. et al. Minimally invasive surgery for resection of duodenal carcinoid tumors: endoscopic full-thickness resection under laparoscopic observation. Surg Endosc 2010; 24: 471-475
- 9 Boškoski I, Volkanovska A, Tringali A. et al. Endoscopic resection for gastrointestinal neuroendocrine tumors. Expert Rev Gastroenterol Hepatol 2013; 7: 559-569
- 10 Yamasaki Y, Uedo N, Takeuchi Y. et al. Current status of endoscopic resection for superficial nonampullary duodenal epithelial tumors. Digestion 2018; 97: 45-51
- 11 Rajan E, Wong Kee Song LM. Endoscopic full thickness resection. Gastroenterology 2018; 154: 1925-1937.e2
- 12 Singh A, Siddiqui UD, Konda VJ. et al. Safety and efficacy of EMR for sporadic, nonampullary duodenal adenomas: a single U.S. center experience (with video). Gastrointest Endosc 2016; 84: 700-708
- 13 Min B-H, 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
- 14 Rösch T, Kapfer B, Will U. et al. Accuracy of endoscopic ultrasonography in upper gastrointestinal submucosal lesions: a prospective multicenter study. Scand J Gastroenterol 2002; 37: 856-862
- 15 Moher D, Liberati A, Tetzlaff J. et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6: e1000097
- 16 Slim K, Nini E, Forestier D. et al. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 2003; 73: 712-716
- 17 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
- 18 Kim SH, Park CH, Ki HS. et al. Endoscopic treatment of duodenal neuroendocrine tumors. Clin Endosc 2013; 46: 656
- 19 Shroff SR, Kushnir VM, Wani SB. et al. Efficacy of endoscopic mucosal resection for management of small duodenal neuroendocrine tumors. Surg Laparosc Endosc Percutan Tech 2015; 25: e134-e139
- 20 Kim GH, Kim JI, Jeon SW. et al. Endoscopic resection for duodenal carcinoid tumors: A multicenter, retrospective study: Endoscopic resection of duodenal carcinoids. J Gastroenterol Hepatol 2014; 29: 318-324
- 21 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
- 22 Gincul R, Ponchon T, Napoleon B. et al. Endoscopic treatment of sporadic small duodenal and ampullary neuroendocrine tumors. Endoscopy 2016; 48: 979-986
- 23 Hatta W, Koike T, Iijima K. et al. The risk factors for metastasis in non-ampullary duodenal neuroendocrine tumors measuring 20 mm or less in diameter. Digestion 2017; 95: 201-209
- 24 Park SB, Kang DH, Choi CW et al. Clinical outcomes of ligation-assisted endoscopic resection for duodenal neuroendocrine tumors. Medicine (Baltimore) 2018; 97: e0533
- 25 Mahmud N, Tomizawa Y, Stashek KM. et al. 1028 - Endoscopic Resection of duodenal carcinoid tumors: a single center comparison between simple polypectomy and endoscopic mucosal resection. Gastroenterology 2018; 154: 196-197
- 26 Vanoli A, La Rosa S, Klersy C. et al. Four Neuroendocrine tumor types and neuroendocrine carcinoma of the duodenum: analysis of 203 cases. Neuroendocrinology 2017; 104: 112-125
- 27 Untch BR, Bonner KP, Roggin KK. et al. Pathologic grade and tumor size are associated with recurrence-free survival in patients with duodenal neuroendocrine tumors. J Gastrointest Surg 2014; 18: 457-463
- 28 Panzuto F, Massironi S, Partelli S. et al. Gastro-entero-pancreatic neuroendocrine neoplasia: The rules for non-operative management. Surg Oncol 2020; 35: 141-148
- 29 da Costa RD, Kemp R, do Santos JS. et al. The role of conventional echoendoscopy (eus) in therapeutic decisions in patients with neuroendocrine gastrointestinal tumors. ABCD Arq Bras Cir Dig São Paulo 2020; 33: e1512
- 30 Varas MJ, Gornals JB, Pons C. et al. Usefulness of endoscopic ultrasonography (EUS) for selecting carcinoid tumors as candidates to endoscopic resection. Rev Esp Enfermedades Dig 2010; 102
- 31 Nagtegaal ID, Odze RD, Klimstra D. et al. The 2019 WHO classification of tumours of the digestive system. Histopathology 2020; 76: 182-188
- 32 Matsumoto S, Miyatani H, Yoshida Y. Endoscopic submucosal dissection for duodenal tumors: a single-center experience. Endoscopy 2012; 45: 136-137
- 33 Delle Fave G, O’Toole D, Sundin A. et al. ENETS Consensus Guidelines Update for Gastroduodenal Neuroendocrine Neoplasms. Neuroendocrinology 2016; 103: 119-124
- 34 Massironi S, Rossi RE. ASO Author reflections: heterogeneity of duodenal neuroendocrine tumors. Ann Surg Oncol 2018; 25: 858-859