Nishio Masafumi, Hirasawa Kingo, Ozeki Yuichiro, Sawada Atsushi, Ikeda Ryosuke, Fukuchi Takehide, Kobayashi Ryosuke, Makazu Makomo, Sato Chiko, Maeda Shin
Division of Endoscopy, Yokohama City University Medical Center (Masafumi Nishio, Kingo Hirasawa, Yuichiro Ozeki, Atsushi Sawada, Ryosuke Ikeda, Takehide Fukuchi, Ryosuke Kobayashi, Makomo Makazu, Chiko Sato).
Department of Gastoenterology, Yokohama City University Guraduate School of Medicine (Shin Maeda), Japan.
Ann Gastroenterol. 2020 May-Jun;33(3):265-271. doi: 10.20524/aog.2020.0477. Epub 2020 Apr 13.
Endoscopic resection is recommended for non-ampullary duodenal neuroendocrine tumors (NAD-NETs) ≤10 mm in diameter and confined to the submucosal layer, without lymph node or distant metastasis. However, the efficacy and safety of endoscopic submucosal dissection (ESD) for NAD-NET remains unclear. The aim of this study was to assess the short-term efficacy and safety and the long-term outcomes of ESD for NAD-NET.
Eight patients with 8 NAD-NETs who underwent ESD between 2015 and 2018 were included. The indications for ESD were: i) tumor ≤10 mm in diameter; ii) NET G1; iii) confined to the submucosal layer; and iv) without lymph node or distant metastasis. We retrospectively assessed the short- and long-term outcomes and safety.
The median patient age was 69 (48-76) years. All tumors were located in the duodenal bulb and showed 0-Is morphology. The median size was 6.4 (3-9.3) mm. The rates of resection, histologically free horizontal and vertical margins, and curative resection were 100%, 88%, and 88%, respectively. Intraoperative and postoperative perforation each occurred in 13% of patients, all of whom were treated conservatively and avoided emergent surgery. Delayed bleeding was not observed. No local, lymph node or distant recurrence was observed during a median follow-up period of 34 (18.5-62.5) months.
The rates of and curative resection, and histologically free margins were sufficiently high. Although intraoperative and postoperative perforations occurred, emergency surgery was not needed. The results show that ESD is an efficacious and safe treatment for NAD-NET.
对于直径≤10mm、局限于黏膜下层且无淋巴结或远处转移的非壶腹十二指肠神经内分泌肿瘤（NAD-NETs），推荐采用内镜切除术。然而，内镜黏膜下剥离术（ESD）治疗NAD-NET的疗效和安全性仍不明确。本研究的目的是评估ESD治疗NAD-NET的短期疗效、安全性及长期预后。
纳入2015年至2018年间接受ESD治疗的8例NAD-NET患者。ESD的适应证为：i）肿瘤直径≤10mm；ii）NET G1；iii）局限于黏膜下层；iv）无淋巴结或远处转移。我们回顾性评估了短期和长期预后及安全性。
患者中位年龄为69（48 - 76）岁。所有肿瘤均位于十二指肠球部，表现为0-Is形态。中位大小为6.4（3 - 9.3）mm。切除率、组织学切缘阴性的水平和垂直切缘率以及根治性切除率分别为100%、88%和88%。术中及术后穿孔各发生在13%的患者中，所有患者均接受保守治疗，避免了急诊手术。未观察到延迟出血。在中位随访期34（18.5 - 62.5）个月内，未观察到局部、淋巴结或远处复发。
切除率、根治性切除率和组织学切缘阴性率足够高。虽然术中及术后发生了穿孔，但无需急诊手术。结果表明，ESD是治疗NAD-NET的一种有效且安全的方法。
