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Endoscopic Management of Diminutive Duodenal Neuroendocrine Tumors

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Journal of Gastrointestinal Cancer Aims and scope Submit manuscript

Abstract

Introduction

Although duodenal neuroendocrine tumors (dNETs) are rare, the incidence, particularly for lesions ≤ 10 mm, continues to rise with the advent of widely available, high-quality endoscopy. Given their rarity and controversy regarding prognostication factors, limited guidelines exist for resection of well-differentiated, ≤ 20-mm dNETs. Importantly, lesions ≤ 10 mm in a duodenal location are ideal for consideration of endoscopic management given both morbidity and technical challenges associated with surgery and their accessibility to a wide range of endoscopic techniques.

Objectives

The primary objective of this study was to demonstrate the safety and efficacy of the endoscopic resection of dNETs <10 mm in a case series and literature review.

Methods

We performed a literature review and present a series of nine cases to demonstrate the viability of endoscopic resection for diminutive dNETs as an alternative to surgery.

Results

Our case series included nine well-differentiated diminutive dNETs in seven patients, the majority resected using endoscopic mucosal resection (EMR), 67%, and there was no residual disease at follow-up. The literature review of 178 patients demonstrated that EMR was the most used method of resection of diminutive dNETs, 81%, compared to endoscopic submucosal dissection, 19%. The most common complication was intraoperative bleeding in 9.55%, and only 2.25% of patients had recurrence.

Conclusion

While complications may arise with endoscopic resection of diminutive dNETs, they are usually managed endoscopically and compare favorably with the literature on surgical complication rates and typically result in shorter hospitalizations.

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Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

dNETs:

Duodenal neuroendocrine tumors

NET:

Neuroendocrine tumors

GI-NETs:

Gastrointestinal neuroendocrine tumors

ENETS:

European Neuroendocrine Tumor Society

EMR:

Endoscopic mucosal resection

EMR-L:

Endoscopic mucosal resection with a ligation device

ESD:

Endoscopic submucosal dissection

EUS:

Endoscopic ultrasound

WHO:

World Health Organization

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Authors and Affiliations

  1. Department of Medicine, University of British Columbia, 319-630 Broadway East, Vancouver, BC, V5T 0J1, Canada

    Natasha Klemm

  2. Faculty of Medicine, University of British Columbia, 119-2190 West 7th, Vancouver, BC, V6K 4K7, Canada

    Destiny Lu-Cleary

  3. Division of Gastroenterology Fellowship, University of British Columbia, Vancouver, BC, Canada

    Daljeet Chahal & Roberto Trasolini

  4. Gordon and Leslie Diamond Health Centre, Vancouver General Hospital, 5153-2775 Laurie St., Vancouver, BC, V5Z 1M9, Canada

    Daljeet Chahal, Roberto Trasolini & Fergal Donnellan

  5. Division of Gastroenterology, St. Paul’s Hospital, 770-1190 Hornby St., Vancouver, BC, V6Z 2K5, Canada

    Eric Lam

  6. Division of Gastroenterology, Vancouver General Hospital, Vancouver, BC, Canada

    Fergal Donnellan

Authors
  1. Natasha Klemm
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  2. Destiny Lu-Cleary
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  3. Daljeet Chahal
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  4. Roberto Trasolini
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Correspondence to Natasha Klemm.

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Klemm, N., Lu-Cleary, D., Chahal, D. et al. Endoscopic Management of Diminutive Duodenal Neuroendocrine Tumors. J Gastrointest Canc 52, 448–453 (2021). https://doi.org/10.1007/s12029-020-00577-8

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  • DOI: https://doi.org/10.1007/s12029-020-00577-8

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