Abstract
BackgroundNeuroendocrine tumors (NETs), as a rare and heterogeneous category of solid tumors, feature various morphologies and behaviors. In recent years, the incidence of NETs has continued to increase. Endoscopic mucosal resection (EMR) is one of the therapeutic modalities for the treatment of gastric and rectal NETs.MethodsWe evaluated patients with well-differentiated NETs of the stomach, duodenum, or rectum between 2011 and 2018. In this study, all cases with tumors confined to the mucosal or submucosal layers and smaller than 20 mm were resected using the EMR technique. We used EUS, CT scan, or MRI to exclude patients with advanced disease. All patients were actively monitored for recurrence according to the recommended protocols.ResultsA total of 36 patients with NETs entered the study; 17 (47.2%) were female and the remaining 19 (52.8%) were male, with a total age range of 20–74 years (mean: 52.47 ± 13.47 years). Among the tumors, 31 cases (86.1%) were G1 and the remaining 5 (13.9%) were G2. Based on the pathology reports, 22 tumors (61.1%) were smaller than 1 cm, while the remaining 14 (38.9%) were between 1–2 cm. Twenty-two patients (61.1%) had a margin of specimen involved with the tumor. No recurrence was observed during the mean follow-up time of 63.5 ± 19.8 months (range: 39–103 months). All 36 cases survived during the study period.ConclusionConventional EMR procedure provides low chance of R0 (complete resection) achievement in gastrointestinal NETs smaller than 20 mm and limited to the mucosa or sub mucosa. However, it could be an option if patients are closely followed. Postoperative marginal involvement is not a reliable predictor of disease recurrence, which may be explained by the deleterious effect of heat coagulation and cauterization applied during tumor removal.
Highlights
Gastrointestinal neuroendocrine tumors (NETs), called carcinoid tumors, feature a wide spectrum of malignant potential and originate from enterochromaffin-like (ECL) cells
4 patients were treated with modified Endoscopic mucosal resection (EMR) and all of them had no resection margin involvement
All of them were below 1 cm.Twenty-two (61.1%) patients had a margin of specimen involved with the tumor
Summary
Gastrointestinal neuroendocrine tumors (NETs), called carcinoid tumors, feature a wide spectrum of malignant potential and originate from enterochromaffin-like (ECL) cells. Endoscopic mucosal resection (EMR) and endoscopic sub mucosal dissection (ESD) are the two endoscopic techniques used to treat NETs. The EMR technique is a relatively simple technique requiring unsophisticated skills and inexpensive tools. The EMR technique is a relatively simple technique requiring unsophisticated skills and inexpensive tools This technique is used for well-differentiated gastric or duodenal lesions smaller than 20 mm in diameter and well-differentiated tumors confined to the mucosal layer without invasion to the lymph nodes or blood vessels. NETs of the rectum that are smaller than 10 mm in diameter are typically confined to the submucosal layer. These small tumors are usually not invasive; they are good candidates for colonoscopic removal by EMR or ESD. Endoscopic mucosal resection (EMR) is one of the therapeutic modalities for the treatment of gastric and rectal NETs
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