Response to Letter to Editor: Advances in Endoscopic Techniques for Resection of Duodenal Neuroendocrine Tumours Response to: Outcomes of Surgical and Endoscopic Resection of Duodenal Neuroendocrine Tumours (NETs): a Systematic Review of the Literature

Background. Duodenal neuroendocrine tumours are very rare, if they are limited to the mucosal layer and have no nodal involvement, endoscopic resection may be curative. Case report. We present the case of a Mexican 52 years old female with a duodenal neuroendocrine tumour who underwent successful endoscopic submucosal dissection with no complications. Pathology of the specimen revealed a complete R0 resection with negative resection margins. Endoscopic biopsies 4 weeks later showed no malignant cells. Conclusions. Because of their low frequency the management of primary duodenal carcinoid tumours is controversial; for tumours less than 1 cm endoscopic resection is recommended, for those bigger than 2 cm surgical resection is advised. Management of tumours between 1 and 2 cm is controversial and should be individualized.

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A82 SUCCESSFUL RESECTION OF GRADE 1 DUODENAL NEUROENDOCRINE TUMOURS USING ENDOSCOPIC TECHNIQUES IN TWO CANADIAN HOSPITALS

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwz047.081 ◽

2020 ◽

Vol 3 (Supplement_1) ◽

pp. 96-97

Author(s):

N K Klemm ◽

D Lu-Cleary ◽

D Chahal ◽

R Trasolini ◽

E Lam ◽

...

Keyword(s):

Literature Review ◽

Endoscopic Resection ◽

Neuroendocrine Tumours ◽

Residual Disease ◽

Duodenal Bulb ◽

Muscularis Propria ◽

Duodenal Perforation ◽

En Bloc ◽

Well Differentiated ◽

Duodenal Neuroendocrine Tumours

Abstract Background Given the rarity of duodenal neuroendocrine tumours (dNETs), limited guidelines exist for resection of well-differentiated, ≤10 mm dNETS. As incidence rises, alternatives to surgery are valuable. We present 9 cases of endoscopic dNET resections and a literature review. Aims To demonstrate efficacy and safety of endoscopic resection for dNETs ≤10 mm at 2 Canadian hospitals. Methods We retrospectively analyzed data on 7 patients that had endoscopic dNET resection from 2013–2018. Endoscopic resection occurred if dNETs were ≤10 mm in diameter, did not extend to the muscularis propria and lymphovascular invasion was absent. WHO 2017 classification was used. Results All patients had biopsies and 5 (71%) had EUS prior to resection; 4 females and 3 males underwent resection of 9 dNETs; 2 via cap-assisted snare polypectomy; 4 with cap-assisted band mucosectomy; and 2 over-the-scope clip-assisted resection. The median size was 10 mm (4–11); 6 (67%) dNETS were found in the duodenal bulb, 2 at the D1/D2 junction and 1 in D2 alone. The median age was 68.5 (50–79) years. All dNETs were submucosal and well-differentiated. The dNETs were resected en bloc, but 3 did not have clear margins. Two procedures were complicated by duodenal perforation; 1 requiring surgery and 18 days in hospital. One case was complicated by bleeding with successful endoscopic hemostasis. The majority (75%) of resections were day procedures. Patients were followed for 6–12 months with an EGD or chromogrannin A. None of the patients had endoscopic residual disease, but 1 patient required a second procedure to remove a dNET left in situ following the initial resection of 2 dNETs 12 months earlier. In our literature review of 178 patients, the majority of dNETs were resected by EMR 81% (150/185) versus ESD, similar to our experience. Patients were slightly younger with a mean age of 63.28, and most dNETs (46%) were found in the duodenal bulb. Complications included intraoperative bleeding, perforation and death in 17 (9.55%), 9 (5.06%) and 1 (0.06%) patient(s) respectively. The rate of recurrence was 4/178 (2.25%) and patients had a mean follow up of 26.1 months. Conclusions Well-differentiated dNETs ≤10 mm in diameter can be successfully resected endoscopically. Complications can be managed intraoperatively and hospital stay remains minimal. Funding Agencies None

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Exclusive Endoscopic Resection of Juvenile Nasopharyngeal Angiofibroma: A Systematic Review of the Literature

Otolaryngology ◽

10.1177/0194599814541627a283 ◽

2014 ◽

Vol 151 (1_suppl) ◽

pp. P119-P120

Author(s):

Nadim P. Khoueir ◽

Nicolas Nicolas ◽

Ziad Rohayem ◽

Amine Haddad ◽

Walid M. Abou Hamad

Keyword(s):

Systematic Review ◽

Endoscopic Resection ◽

Juvenile Nasopharyngeal Angiofibroma ◽

Review Of The Literature ◽

Nasopharyngeal Angiofibroma

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Tu1516 SUCCESSFUL RESECTION OF GRADE 1 DUODENAL NEUROENDOCRINE TUMOURS USING ENDOSCOPIC TECHNIQUES IN TWO CANADIAN HOSPITALS.

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2020.03.3688 ◽

2020 ◽

Vol 91 (6) ◽

pp. AB599-AB600

Author(s):

Natasha K. Klemm ◽

Destiny Lu-Cleary ◽

Daljeet Chahal ◽

Roberto Trasolini ◽

Eric Lam ◽

...

Keyword(s):

Neuroendocrine Tumours ◽

Endoscopic Techniques ◽

Duodenal Neuroendocrine Tumours

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Comparison of Endoscopic Techniques in the Management of Type I Gastric Neuroendocrine Neoplasia: A Systematic Review

Gastroenterology Research and Practice ◽

10.1155/2021/6679397 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Francesco Panzuto ◽

Ludovica Magi ◽

Gianluca Esposito ◽

Maria Rinzivillo ◽

Bruno Annibale

Keyword(s):

Systematic Review ◽

Endoscopic Resection ◽

Final Analysis ◽

En Bloc Resection ◽

Endoscopic Technique ◽

Endoscopic Management ◽

Type I ◽

En Bloc ◽

Endoscopic Techniques ◽

Neuroendocrine Neoplasia

Background. Endoscopic resection is considered the treatment of choice for type I gastric neuroendocrine neoplasia (gNEN) given its indolent behaviour; however, the favoured endoscopic technique to remove these tumours is not well established. Aims. This systematic review is aimed at investigating the best endoscopic management for type I gNEN. Methods. PubMed Central/Medline and Scopus were systematically searched for records up to August 31, 2020. Results. After screening the 675 retrieved records, 6 studies were selected for the final analysis. The main endoscopic resection techniques described were endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). Overall, 112 gNENs were removed by EMR and 77 by ESD. Both techniques showed similar results for complete and en bloc resection (97.4% and 98.7%; 92.3% and 96.3% with ESD and EMR, respectively). ESD was associated with a higher rate of complications than EMR (11.7% vs. 5.4%), but this difference was not statistically significant ( p = 0.17 ). The rates of recurrence during follow-up were 18.2% and 11.5% for EMR and ESD, respectively. Conclusions. To date, there are no sufficient data showing superiority of a given endoscopic technique over others. Both ESD and EMR seem to be effective in the management of type I gNEN, with a relatively low rate of recurrence.

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Telepractice for Adult Speech-Language Pathology Services: A Systematic Review

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_persp-19-00146 ◽

2020 ◽

Vol 5 (1) ◽

pp. 326-338 ◽

Cited By ~ 9

Author(s):

Kristen Weidner ◽

Joneen Lowman

Keyword(s):

Systematic Review ◽

Primary Progressive Aphasia ◽

Future Research ◽

Service Delivery Model ◽

Speech Language Pathology ◽

Review Of The Literature ◽

Research Designs ◽

Assessment And Treatment ◽

Language Pathology ◽

Screening Assessment

Purpose We conducted a systematic review of the literature regarding adult telepractice services (screening, assessment, and treatment) from approximately 2014 to 2019. Method Thirty-one relevant studies were identified from a literature search, assessed for quality, and reported. Results Included studies illustrated feasibility, efficacy, diagnostic accuracy, and noninferiority of various speech-language pathology services across adult populations, including chronic aphasia, Parkinson's disease, dysphagia, and primary progressive aphasia. Technical aspects of the equipment and software used to deliver services were discussed. Some general themes were noted as areas for future research. Conclusion Overall, results of the review continue to support the use of telepractice as an appropriate service delivery model in speech-language pathology for adults. Strong research designs, including experimental control, across multiple well-described settings are still needed to definitively determine effectiveness of telepractice services.

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Acute limb ischemia in a patient with pre-fibrotic myelofibrosis complicated by heparin-induced thrombocytopenia and thrombosis – case report and systematic review of dabigatran use

VASA ◽

10.1024/0301-1526/a000876 ◽

2020 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Marina Di Pilla ◽

Stefano Barco ◽

Clara Sacco ◽

Giovanni Barosi ◽

Corrado Lodigiani

Keyword(s):

Systematic Review ◽

Case Report ◽

Lower Limb ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

Review Of The Literature ◽

Heparin Induced Thrombocytopenia ◽

Lower Limb Ischemia ◽

Vein Thrombosis ◽

Left Lower Limb

Summary: A 49-year-old man was diagnosed with pre-fibrotic myelofibrosis after acute left lower-limb ischemia requiring amputation and portal vein thrombosis. After surgery he developed heparin-induced thrombocytopenia (HIT) with venous thromboembolism, successfully treated with argatroban followed by dabigatran. Our systematic review of the literature supports the use of dabigatran for suspected HIT.

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