Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
Surg Endosc. 2023 May;37(5):3884-3892. doi: 10.1007/s00464-023-09885-z. Epub 2023 Jan 30.
As the incidence of duodenal neuroendocrine tumors (DNET) is steadily increasing, the role of endoscopic treatment for appropriate lesions is becoming more significant. We aimed to compare the outcomes according to lesion size and endoscopic mucosal resection (EMR) techniques for DNET treatment.
Patients who underwent endoscopic treatment for DNET between June 2000 and December 2019 were included. The clinicopathologic features and treatment outcomes were investigated by reviewing medical records.
Overall, 104 cases underwent endoscopic resection for nonampullary DNET, including conventional EMR (n = 57), cap-assisted EMR (EMR-C, n = 19), and precut EMR (EMR-P, n = 28). The en bloc resection rates (100% vs. 94.7% vs. 96.4%) and histologic complete resection rates (45.6% vs. 52.6% vs. 57.1%) were not significantly different between the EMR, EMR-C, and EMR-P groups. The histologic complete resection rates were significantly higher in lesions < 10 mm than in lesions ≥ 10 mm (69.8% vs. 38.9%, P = 0.013). In lesions < 10 mm, perforation occurred more frequently in the modified EMR group than in the conventional EMR group (13.2% vs. 0.0%, P = 0.007). During the median follow-up period of 88.0 months, the recurrence-free survival (92.2% vs. 94.4% vs. 92.1%) and overall survival (98.0% vs. 88.1% vs. 100.0%) rates did not show significant differences between the EMR, EMR-C, and EMR-P groups.
Conventional EMR and modified EMR are feasible and effective for the treatment of nonampullary DNET sized < 10 mm and limited to mucosal and submucosal layer. Additionally, endoscopists should be aware of the high risk of perforation in modified EMR.
随着十二指肠神经内分泌肿瘤（DNET）的发病率稳步上升，内镜治疗在合适病变中的作用变得越来越重要。我们旨在比较不同大小病变和内镜黏膜切除术（EMR）技术治疗 DNET 的结果。
回顾性分析 2000 年 6 月至 2019 年 12 月期间接受内镜治疗的 DNET 患者的临床病理特征和治疗结果。
共有 104 例非壶腹 DNET 患者接受内镜切除治疗，其中常规 EMR（n=57）、帽辅助 EMR（EMR-C，n=19）和预切开 EMR（EMR-P，n=28）。整块切除率（100% vs. 94.7% vs. 96.4%）和组织学完全切除率（45.6% vs. 52.6% vs. 57.1%）在 EMR、EMR-C 和 EMR-P 组之间无显著差异。病变<10mm 时组织学完全切除率显著高于病变≥10mm（69.8% vs. 38.9%，P=0.013）。在病变<10mm 时，改良 EMR 组穿孔发生率高于常规 EMR 组（13.2% vs. 0.0%，P=0.007）。在中位 88.0 个月的随访期间，EMR、EMR-C 和 EMR-P 组之间无复发生存率（92.2% vs. 94.4% vs. 92.1%）和总生存率（98.0% vs. 88.1% vs. 100.0%）差异无统计学意义。
常规 EMR 和改良 EMR 适用于治疗大小<10mm、局限于黏膜和黏膜下层的非壶腹 DNET。此外，内镜医师应注意改良 EMR 穿孔的高风险。
