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

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

scholarly journals Endoscopic Resection of Esophageal Granular Cell Tumors: A Single Center Experience

2021 ◽  
Author(s):  
Kaipeng Liu ◽  
Yangyang Zhou ◽  
Qingfen Zheng ◽  
Dan Liu ◽  
Huiyu Yang ◽  
...  
Keyword(s):  
Endoscopic Resection ◽  
Muscularis Propria ◽  
Granular Cell ◽  
En Bloc Resection ◽  
Clinicopathological Characteristics ◽  
Maximum Diameter ◽  
R0 Resection ◽  
En Bloc ◽  
Delayed Bleeding ◽  
The Mean

Abstract Background: Granular cell tumors (GCTs) are rare tumors probably originating from neurogenic Schwann cells. The aim was to evaluate the safety and feasibility of endoscopic resection for esophageal GCTs. Methods: The study retrospectively analyzed patients with pathologically diagnosed esophageal GCTs in our center from February 2012 to December 2020. Clinicopathological characteristics, endoscopic features and clinical outcomes were collected and analyzed. Results: 12 males and 10 females were identified. Lesions were located in the upper, middle and lower esophagus in three, six and thirteen cases respectively. 14 lesions (63.6%) exhibited white-to-yellow discoloration. The mean maximum diameter of these lesions was 5.7±2.2 mm (range 2-11.6 mm). The most lesions (91%) were located in the mucosa or submucosa layer, and 2 lesions (9.0%) were in the muscularis propria layer. Endoscopic mucosal resection (n=17), endoscopic submucosal dissection (n=4) and endoscopic submucosal excavation (n=1) were performed. En bloc resection was achieved in 20 lesions (90.9%). The R0 resection was achieved in 20 lesions (90.9%). No patients experienced intraoperative perforation or delayed bleeding in the mean length of postoperative hospital stay of 4.2±2.1 days (range 1-9 days). All patients had no recurrence or metastasis during the mean follow-up period of 48.1±27.2 months (range 2-102 months). Conclusion: Endoscopic resection is safe and effective for management of esophageal GCTs. Clinically, the appropriate approach of endoscopic resection should be selected according to the origin and size of the lesion.

scholarly journals Disección endoscópica submucosa de tumor neuroendocrino primario de duodeno. Reporte de caso y revisión de la literatura

2020 ◽  
Vol 50 (2) ◽  
Author(s):  
Martín Edgardo Rojano Rodríguez ◽  
Elisafat Arce Liévano ◽  
Orlando Bada Yllán ◽  
Carlos Valenzuela Salazar ◽  
Roberto Délano Alonso ◽  
...  
Keyword(s):  
Endoscopic Resection ◽  
Neuroendocrine Tumours ◽  
Neuroendocrine Tumour ◽  
Low Frequency ◽  
Resection Margins ◽  
R0 Resection ◽  
Nodal Involvement ◽  
Mucosal Layer ◽  
Duodenal Neuroendocrine Tumours ◽  
Duodenal Carcinoid

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.

scholarly journals En Bloc Endoscopic Resection of Large Pedunculated Brunner’s Gland Hamartoma: A Case Report

2018 ◽  
Vol 12 (2) ◽  
pp. 344-351
Author(s):  
Annalisa Pasetti ◽  
Elvira Capoferro ◽  
Giulia Querzoli ◽  
Renzo Montanari ◽  
Paolo Bocus
Keyword(s):  
Endoscopic Resection ◽  
Epigastric Pain ◽  
Duodenal Bulb ◽  
Anterior Wall ◽  
Upper Gastrointestinal Endoscopy ◽  
En Bloc ◽  
Brunner’S Gland ◽  
Brunner's Gland ◽  
Brunner’S Gland Hamartoma ◽  
Submucosal Lesion

Brunner’s gland hamartoma (BGH) is an uncommon benign tumor arising from alkaline-based mucin-secreting glands of the duodenum. These lesions are typically discovered incidentally during upper gastrointestinal endoscopy or radiological diagnostics, even though they can eventually lead (in the case of increasing size) to obstructive or hemorrhagic symptoms. We report the case of a 67-year-old Caucasian man with two episodes of melena and epigastric pain during the last month. Esophagogastroduodenoscopy revealed a large pedunculated and eroded polyp inside the antrum with a 2-cm-long stalk arising from the anterior wall of the duodenal bulb. Endoscopic ultrasonography showed a submucosal lesion with homogeneous hyperechoic parietal thickening and some central gaps. The muscularis was undamaged. No lymphadenopathy was observed. We performed an en bloc endoscopic resection of the polyp. The size of the whole piece was approximately 6 × 3 × 2 cm, pseudocapsulated and tough in consistency. In the case presented, the en bloc endoscopic removal was successful despite the size of the tumor.

Outcomes of Surgical and Endoscopic Resection of Duodenal Neuroendocrine Tumours (NETs): a Systematic Review of the Literature

2018 ◽  
Vol 22 (9) ◽  
pp. 1652-1658 ◽  
Author(s):  
Bobby V. M. Dasari ◽  
Sarah Al-Shakhshir ◽  
Timothy M. Pawlik ◽  
Tahir Shah ◽  
Ravi Marudanayagam ◽  
...  
Keyword(s):  
Systematic Review ◽  
Endoscopic Resection ◽  
Neuroendocrine Tumours ◽  
Review Of The Literature ◽  
Duodenal Neuroendocrine Tumours

scholarly journals Open submucosal tunneling endoscopic resection for special submucosal tumors originating from the muscularis propria

2020 ◽  
Author(s):  
Silin Huang ◽  
Sufang Tu ◽  
Jingwen Fu ◽  
Xiaowei Tang ◽  
Genhua Yang ◽  
...  
Keyword(s):  
Endoscopic Resection ◽  
Muscularis Propria ◽  
Operation Time ◽  
Primary Treatment ◽  
En Bloc ◽  
Submucosal Tunneling Endoscopic Resection ◽  
Submucosal Tumors ◽  
Endoscopic Techniques ◽  
The Mean

Abstract Background and Purpose Esophageal submucosal tumors (SMTs) are primarily benign but can have the potential for malignancy. Surgery is the primary treatment; however, the development of endoscopic techniques has promoted the use of endoscopic resection for esophageal SMTs. Submucosal tunneling endoscopic resection (STER) is the current optimal treatment for esophageal SMTs; however, it is challenging to perform in cases of tumors located in the upper esophagus and cardia as well as those with a diameter > 3.5 cm. Based on STER, we proposed and used open STER (O-STER) for special esophageal SMTs. The study aimed to evaluate the safety and efficacy of O-STER for special esophageal SMTs, including those located in the upper esophagus and cardia and those with a diameter > 3.5 cm. Methods The study enrolled 21 patients whose baseline characteristics, clinical data, and follow-up results were retrospectively analyzed. Results A total of 21 lesions were resected. The mean patient age was 44.2 ± 14.4 years. The mean tumor size was 38.2 ± 12.2 mm; 16 (76.2%) tumors had a diameter ≥ 3.5 cm. Tumors were in the cardia in 14 (66.7%) cases and in the upper esophagus in 2 (9.5%) cases. The mean operation time was 56.7 ± 19.3 minutes. The en bloc and complete resection rates were both 100%. There was 1 (4.8%) case of subcutaneous emphysema; no other serious complications were noted. Pathological examinations suggested that most tumors were leiomyomas and had negative margins. During the mean follow-up period of 26.7 months, no cases of residue, recurrence, or metastasis were observed. Conclusions O-STER is a safe and effective treatment for special esophageal SMTs that can reduce operative difficulty and complication rate.

scholarly journals pT1 Colorectal Cancer Detected in a Colorectal Cancer Mass Screening Program: Treatment and Factors Associated with Residual and Extraluminal Disease

Cancers ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2530
Author(s):  
Joaquín Cubiella ◽  
Antía González ◽  
Raquel Almazán ◽  
Elena Rodríguez-Camacho ◽  
Juana Fontenla Rodiles ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Mass Screening ◽  
Endoscopic Resection ◽  
Residual Disease ◽  
Screening Program ◽  
Safe Procedure ◽  
Crc Screening ◽  
Factors Associated ◽  
Well Differentiated ◽  
Vascular Infiltration

The aim of this study is to describe the treatment of pT1 colorectal cancer (CRC) in a mass screening program, the surgery-related complications and the factors associated with residual disease after endoscopic resection and extraluminal disease after surgery. We included in this retrospective analysis all the pT1 CRC detected in the Galician CRC screening program between May 2013 and June 2019. We determined which variables were independently associated with the outcomes of the study through a multivariable logistic regression analysis. We included 370–354 pT1 N0(X), 16 pT1N1- out of the 971 CRC detected; 277 (74.9%) were resected endoscopically and 162 (43.8%) were not referred to surgery. There were surgical complications in 30.7% and 16.3% of the patients during hospitalization and after discharge. Residual disease was detected in 12 (4.3%) after endoscopic resection and extraluminal disease in 18 (8.6%) patients after surgery. The variables independently associated with initial endoscopic resection were a pedunculated morphology (OR 33.1, 95% CI 4.3–254), a diameter ≥ 20 mm (OR 3.94, 95% CI 1.39–11.18) and a Site–Morphology–Size–Access score < 9 (OR 428, 95% CI 42–4263). The variables related with surgery rescue were a piecemeal resection (OR 4.48, 95% CI 1.48–13.6), an infiltrated/nonevaluable resection border (OR 7.44, 95% CI 2.12–26.0), a non-well-differentiated histology (OR 4.76, 95% CI 1.07–20.0), vascular infiltration (OR 8.24, 95% CI 2.72–25.0) and a Haggitt 4 infiltration of the submucosa (OR 5.68, 95% CI 2.62–12.3). Residual disease after endoscopic resection was associated with an infiltrated/nonevaluable resection border (OR 34.9, 95% CI 4.08–298), a non-well-differentiated histology (OR 6.67, 95% CI 1.05–50.0), and the vascular infiltration of the submucosa (OR 7.61, 95% CI 1.55–37.4). The variables related with extraluminal disease after surgical resection were no endoscopic resection (OR 4.34, 95% CI 1.26–14.28), a non-well-differentiated histology (OR 4.35, 95% CI 1.39–14.29) and the lymphatic infiltration of the submucosa (OR 4.8, 95% CI 1.32–17.8). In a CRC screening program, although most of pT1 CRC are candidates for endoscopic treatment, surgery is a safe procedure. We have defined some easy to evaluate variables that can be used in the decision-making process.

Primary neuroendocrine tumours of the heart: case report and literature review

2021 ◽  
Vol 14 (6) ◽  
pp. e242517
Author(s):  
Ellery Altshuler ◽  
Haneen Saker ◽  
Brian Ramnaraign
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
Gastrointestinal Tract ◽  
Literature Review ◽  
Neuroendocrine Tumours ◽  
Low Grade ◽  
Review Of The Literature ◽  
Cardiac Tumours ◽  
Well Differentiated ◽  
Neuroendocrine Carcinomas

Neuroendocrine tumours occur most frequently in the gastrointestinal tract, lungs, and pancreas. Primary malignant cardiac tumours are uncommon and are usually sarcomas, lymphomas, or, infrequently, mesotheliomas. Primary cardiac neuroendocrine carcinomas are exceedingly rare; only nine have been reported in the literature to date. We report the tenth case of this disorder in a 44-year-old man with a well-differentiated low-grade primary cardiac neuroendocrine carcinoma treated with surgery who remains in remission more than a year later. Our case and review of the literature demonstrate that surgical treatment for well-differentiated primary cardiac neuroendocrine carcinomas can be effective.

Neuroendocrine Tumors of the Rectum: A 10-Year Review of Management

2011 ◽  
Vol 77 (2) ◽  
pp. 198-200 ◽  
Author(s):  
Jason R. Moore ◽  
Brian Greenwell ◽  
Kaylee Nuckolls ◽  
David Schammel ◽  
Nicholas Schisler ◽  
...  
Keyword(s):  
Neuroendocrine Tumors ◽  
Local Excision ◽  
Neuroendocrine Carcinoma ◽  
Residual Disease ◽  
Muscularis Propria ◽  
Positive Margins ◽  
Pathologic Evaluation ◽  
Poorly Differentiated Neuroendocrine Carcinoma ◽  
Poorly Differentiated ◽  
Well Differentiated

Neuroendocrine tumors of the rectum constitute ∼19 per cent of gastrointestinal neuroendocrine tumors (NETs). The histologic characteristics of the tumor seem to be an indicative prognostic factor. Optimal treatment of NETS of the rectum has been widely debated, but more recent studies suggest that treatment depends upon the size. The medical records of 37 patients with NETS of the rectum were retrospectively reviewed. We reviewed their presentation, surgical treatment, pathology, and outcome. All pathological specimens were reviewed. Neuroendocrine tumors of the rectum were classified as either well-differentiated tumors, well-differentiated neuroendocrine carcinoma, or poorly differentiated neuroendocrine carcinoma. Evaluating tumor size, we found 35/37 patients had tumors less than 1 cm, 1 patient had a tumor between 1 and 2 cm, and one had a tumor greater than 2 cm. Pathologic evaluation of the tumors revealed that 35 of the tumors invaded the submucosa only, one invaded the muscularis propria, and one invaded the perirectal adipose tissue. The histopathologic features of the tumors revealed that 34 of the tumors were well-differentiated NETS with benign features, one tumor had invaded the submucosa, with angioinvasion, and two tumors were neuroendocrine carcinoma. Thirty-five patients underwent local excision. Eleven had reexcisions for positive margins. Two patients had local excision for recurrence, and one patient underwent low anterior resection (4 cm). Twelve patients had negative margins, 25 had positive margins. Eleven patients underwent reexcision. Six had no evidence of residual disease, and five had persistent positive margins and were offered no further treatment. Nineteen patients had positive margins and did not have reexcision. They all had tumors < 1 cm. Despite half of the lesions being resected with final pathologic positive margins, we have seen no significant influence on recurrence or overall survival. This raises the question of margin clearance in early lesions.

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