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Published on: December 20, 2024
Efficacy of Endoscopic Mucosal Resection for Management of Small Duodenal Neuroendocrine Tumors
Sagar R Shroff1, Vladimir M Kushnir, Sachin B Wani
1Department of Medicine, Division of Gastroenterology and Hepatology, Washington University, St Louis, MO.
Background:
Endoscopic mucosal resection (EMR) for small (<20 mm) duodenal neuroendocrine tumors (NETs) remains controversial because of their rarity.
Materials And Methods:
This is a retrospective cohort study of patients with surgically or endoscopically resected duodenal NETs from 2001 to 2011. The primary outcome is the rate of disease-free status following resection. A secondary outcome is the sensitivity of endoscopic ultrasound (EUS) in determining NET appropriateness for EMR.
Results:
Thirty patients underwent resection of duodenal NETs (EMR 20, surgery 10). Tumor was present at the margins in 40% of EMR-resected NETs and 10% of surgically resected NETs. Five patients who underwent EMR had residual disease treated with repeat EMR (3) and surgery (2). EUS demonstrated 96% sensitivity in determining lesions limited to the submucosa.
Conclusions:
EMR for small duodenal NETs can be a safe and effective alternative to surgery in carefully selected patients. EUS is a useful adjunct in determining depth of invasion for duodenal NETs.
Insights
Endoscopic mucosal resection (EMR) for duodenal neuroendocrine tumors (NETs) is effective in select cases. Endoscopic ultrasound (EUS) aids in selecting patients for EMR, improving outcomes for these rare tumors.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Endocrinology
Background:
- Small duodenal neuroendocrine tumors (NETs) are rare, making treatment decisions like endoscopic mucosal resection (EMR) controversial.
- Assessing the efficacy and safety of EMR versus surgery for duodenal NETs is crucial.
Purpose of the Study:
- To evaluate the disease-free status after EMR and surgical resection of duodenal NETs.
- To determine the sensitivity of endoscopic ultrasound (EUS) in guiding EMR suitability for duodenal NETs.
Main Methods:
- Retrospective cohort study of 30 patients with duodenal NETs treated between 2001 and 2011.
- Comparison of outcomes between EMR (n=20) and surgical resection (n=10).
- Assessment of EUS sensitivity for identifying submucosal lesions.
Main Results:
- EMR had a 40% positive margin rate compared to 10% for surgery.
- Five EMR patients experienced residual disease, requiring further treatment.
- EUS showed 96% sensitivity in detecting submucosal invasion.
Conclusions:
- EMR is a viable alternative to surgery for carefully selected duodenal NET patients.
- EUS is valuable for assessing tumor invasion depth and patient selection for EMR.
