Pimentel-Nunes Pedro, Ortigão Raquel, Afonso Luís Pedro, Bastos Rui Pedro, Libânio Diogo, Dinis-Ribeiro Mário
Department of Gastroenterology, Portuguese Oncology Institute - Porto, Porto, Portugal.
Department of Surgery and Physiology, Porto Faculty of Medicine, Porto, Portugal.
GE Port J Gastroenterol. 2022 Mar 14;30(2):98-106. doi: 10.1159/000521654. eCollection 2023 Mar.
Gastrointestinal neuroendocrine tumors (GI-NETs) are being more frequently diagnosed and treated by endoscopic resection (ER) techniques. However, comparison studies of the different ER techniques or long-term outcomes are rarely reported.
This was a single-center retrospective study analyzing short and long-term outcomes after ER of gastric, duodenum, and rectal GI-NETs. Comparison between standard EMR (sEMR), EMR with a cap (EMRc), and endoscopic submucosal dissection (ESD) was made.
Fifty-three patients with GI-NET (25 gastric, 15 duodenal, and 13 rectal; sEMR = 21; EMRc = 19; ESD = 13) were included in the analysis. Median tumor size was 11 mm (range 4-20), significantly larger in the ESD and EMRc groups compared to the sEMR group ( < 0.05). Complete ER was possible in all cases with 68% histological complete resection (no difference between the groups). Complication rate was significantly higher in the EMRc group (EMRc 32%, ESD 8%, and EMRs 0%, p = 0.01). Local recurrence occurred in only one patient, and systemic recurrence in 6%, with size ≥ 12 mm being a risk factor for systemic recurrence (p = 0.05). Specific disease-free survival after ER was 98%.
ER is a safe and highly effective treatment particularly for less than 12 mm luminal GI-NETs. EMRc is associated with a high complication rate and should be avoided. sEMR is an easy and safe technique that is associated with long-term curability, and it is probably the best therapeutic option for most luminal GI-NETs. ESD appears to be the best option for lesions that cannot be resected en bloc with sEMR. Multicenter, prospective randomized trials should confirm these results.
胃肠道神经内分泌肿瘤（GI-NETs）越来越多地通过内镜切除术（ER）进行诊断和治疗。然而，关于不同ER技术或长期疗效的比较研究报道很少。
这是一项单中心回顾性研究，分析胃、十二指肠和直肠GI-NETs内镜切除术后的短期和长期疗效。对标准内镜黏膜切除术（sEMR）、带帽内镜黏膜切除术（EMRc）和内镜黏膜下剥离术（ESD）进行了比较。
53例GI-NET患者（25例胃、15例十二指肠和13例直肠；sEMR = 21例；EMRc = 19例；ESD = 13例）纳入分析。肿瘤中位大小为11毫米（范围4-20毫米），ESD组和EMRc组明显大于sEMR组（<0.05）。所有病例均可行完全内镜切除，组织学完全切除率为68%（组间无差异）。EMRc组并发症发生率明显更高（EMRc 32%，ESD 8%，sEMR 0%，p = 0.01）。仅1例患者发生局部复发，6%发生全身复发，肿瘤大小≥12毫米是全身复发的危险因素（p = 0.05）。内镜切除术后特定的无病生存率为98%。
内镜切除是一种安全有效的治疗方法，尤其适用于直径小于12毫米的腔内GI-NETs。EMRc并发症发生率高，应避免使用。sEMR是一种简单安全的技术，具有长期治愈性，可能是大多数腔内GI-NETs的最佳治疗选择。ESD似乎是无法用sEMR整块切除病变的最佳选择。多中心前瞻性随机试验应证实这些结果。
