Khara Harshit S, Shovlin Gerald J, Johal Amitpal S, Diehl David L
Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, PA 17822, USA.
Department of Internal Medicine, Geisinger Medical Center, Danville, PA 17822, USA.
Endosc Int Open. 2019 Feb;7(2):E302-E307. doi: 10.1055/a-0684-9563. Epub 2019 Feb 8.
Endoscopic treatment of diminutive (less than 10 mm) duodenal neuroendocrine tumors (NETs) is recommended because of the risk of metastatic potential. Endoscopic mucosal resection and endoscopic submucosal dissection are alternatives to surgical management but have significant adverse event rates. We evaluated the effectiveness, feasibility, and safety of the 'banding without resection' (BWR) technique and assessed outcomes for the treatment of diminutive duodenal NETs. Our study included eight patients referred for endoscopic treatment of incidentally discovered, biopsy proven, diminutive duodenal bulb NETs. Endoscopic ultrasound (EUS) in all patients showed duodenal bulb NETs located in the deep mucosa and submucosal layers without any nodal metastasis. The BWR technique was successfully performed in all patients with technical feasibility, with the assistance of submucosal saline lift in three patients when the lesion was smaller than 5 mm in size, without any immediate or delayed adverse events. Complete resection with no residual lesion was confirmed at short-term (median 2.3 months) and long-term (median 4.2 years) follow-up intervals by repeat endoscopy, biopsy, and EUS exam. The BWR technique appears to be a safe, feasible, and effective therapy for endoscopic treatment of diminutive duodenal bulb NETs in the absence of local and distant metastasis.
由于存在转移风险，推荐对微小（小于10毫米）十二指肠神经内分泌肿瘤（NETs）进行内镜治疗。内镜黏膜切除术和内镜黏膜下剥离术是手术治疗的替代方法，但不良事件发生率较高。我们评估了“不切除套扎”（BWR）技术的有效性、可行性和安全性，并评估了其治疗微小十二指肠NETs的效果。我们的研究纳入了8例因偶然发现、活检证实为微小十二指肠球部NETs而接受内镜治疗的患者。所有患者的内镜超声（EUS）显示十二指肠球部NETs位于黏膜深层和黏膜下层，无任何淋巴结转移。在技术可行的情况下，所有患者均成功实施了BWR技术，3例病变小于5毫米的患者在黏膜下生理盐水抬举辅助下完成操作，无任何即刻或延迟不良事件。通过重复内镜检查、活检和EUS检查，在短期（中位时间2.3个月）和长期（中位时间4.2年）随访期间均证实病变完全切除且无残留。在无局部和远处转移的情况下，BWR技术似乎是内镜治疗微小十二指肠球部NETs的一种安全、可行且有效的治疗方法。
