Abstract
BackgroundGastrointestinal neuroendocrine neoplasms (GI-NENs) are often located in the deep mucosa or submucosa, and the efficacy of endoscopic biopsy for diagnosis and treatment of GI-NENs is not fully understood.ObjectiveThe current study analyzed GI-NENs, especially those diagnosed pathologically and resected endoscopically, and focused on the biopsy and cold biopsy forceps polypectomy (CBP) to analyze their roles in diagnosing and treating GI-NENs.MethodsClinical data of all GI-NENs were reviewed from January 2006 to March 2012. Histopathology was used to diagnose GI-NENs, which were confirmed by immunohistochemistry.Results67.96% GI-NENs were diagnosed pathologically by endoscopy. Only 26.21% were diagnosed pathologically by biopsies before treatment. The diagnostic rate was significantly higher in polypoid (76.47%) and submucosal lesions (68.75%), than in ulcerative lesions (12.00%). However, biopsies were only taken in 56.31% patients, including 51.52% of polypoid lesions, 35.56% of submucosal lesions and 100.00% of ulcerative lesions. Endoscopic resection removed 61.76% of GI-NENs, including six by CBP, 14 by snare polypectomy with electrocauterization, 28 by endoscopic mucosal resection (EMR) and 15 by endoscopic submucosal dissection (ESD). 51.52% polypoid GI-NENs had infiltrated the submucosa under microscopic examination. CBP had a significantly higher rate of remnant (33.33%) than snare polypectomy with electrocauterization, EMR and ESD (all 0.00%).ConclusionsBiopsies for all polypoid and submucosal lesions will improve pre-operative diagnosis. The high rate of submucosal infiltration of polypoid GI-NENs determined that CBP was inadequate in the treatment of GI-NENs. Diminutive polypoid GI-NENs that disappeared after CBP had a high risk of remnant and should be closely followed up over the long term.
Highlights
Gastrointestinal neuroendocrine neoplasms (GI-NENs) are rare types of disease; the incidence and prevalence are increasing rapidly worldwide [1]
The high rate of submucosal infiltration of polypoid GI-NENs determined that cold biopsy forceps polypectomy (CBP) was inadequate in the treatment of GI-NENs
Diminutive polypoid GI-NENs that disappeared after CBP had a high risk of remnant and should be closely followed up over the long term
Summary
Gastrointestinal neuroendocrine neoplasms (GI-NENs) are rare types of disease; the incidence and prevalence are increasing rapidly worldwide [1]. GI-NENs have a wide range of malignant potential: from benign tumor (neuroendocrine tumor, NET) to poorly differentiated carcinoma (neuroendocrine carcinoma, NEC), and surgical removal is the only effective therapy. Well-differentiated NETs without metastasis can be resected locally and curatively [2]. Endoscopic techniques for removing gastrointestinal neoplasm include polypectomy, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) etc. For the treatment of GI-NENs, EMR and ESD are effective [2,3], while polypectomy is under investigation. CBP is commonly used for removing diminutive polyps (#5 mm) [4], and polyps of any size are routinely biopsied for pathological diagnosis before treatment. Gastrointestinal neuroendocrine neoplasms (GI-NENs) are often located in the deep mucosa or submucosa, and the efficacy of endoscopic biopsy for diagnosis and treatment of GI-NENs is not fully understood
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