Clinical Endoscopy

Review

The Role of Endoscopy in Small Bowel Neuroendocrine Tumors: Ji Yoon Yoon, Nikhil A. Kumta, Michelle Kang Kim; Clin Endosc 2021;54(6):818-824. Published online April 1, 2021; DOI: https://doi.org/10.5946/ce.2020.296

Small bowel neuroendocrine tumors (NETs) represent approximately one-third of NETs of the gastrointestinal tract, and their incidence is increasing. When determining if endoscopic resection is appropriate, endoscopic ultrasound is used to assess the lesion size and depth of invasion for duodenal NETs. A number of techniques, including endoscopic mucosal resection (EMR), band-assisted EMR (band-EMR), endoscopic submucosal dissection (ESD), and over-the-scope clip-assisted endoscopic full-thickness resection (EFTR), have been studied; however, the best technique for endoscopic resection remains unclear. The vast majority of currently available data are retrospective, and prospective studies with longer follow-up times are required. For jejunal and ileal NETs, endoscopic techniques such as video capsule endoscopy (VCE) and balloon enteroscopy (BE) assist in diagnosis. This includes localization of the primary NET in metastatic disease where initial workup has been negative, and the identification of multifocal disease, which may change management and prognostication.

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Ileal Neuroendocrine Tumors Detected During Screening or Diagnostic Colonoscopy — Case Series and Comparison of Tumor Characteristics
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Imaging of Small-Bowel Neuroendocrine Neoplasms: AJR Expert Panel Narrative Review
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American Journal of Roentgenology.2023; 221(3): 289. CrossRef
Magnifying Endoscopy with Narrow-Band Imaging for Duodenal Neuroendocrine Tumors
Gwang Ha Kim, Kiyoun Yi, Dong Chan Joo, Moon Won Lee, Hye Kyung Jeon, Bong Eun Lee
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Long-term outcomes of endoscopic resection for duodenal neuroendocrine tumors
Kiyoun Yi, Gwang Ha Kim, Su Jin Kim, Cheol Woong Choi, Moon Won Lee, Bong Eun Lee, Geun Am Song
Scientific Reports.2023;[Epub] CrossRef
Small Bowel Neuroendocrine Neoplasms—A Review
Sai Swarupa Vulasala, Mayur Virarkar, Dheeraj Gopireddy, Rebecca Waters, Ahmad Alkhasawneh, Ziad Awad, Jessica Maxwell, Nisha Ramani, Sindhu Kumar, Nirmal Onteddu, Ajaykumar C. Morani
Journal of Computer Assisted Tomography.2023;[Epub] CrossRef
Performance of capsule endoscopy for the detection of small intestinal neuroendocrine tumors in familial carcinoid: a prospective single-site study
Derek Tang, Ramona Lim, Louis Korman, Joanne Forbes, Kristen Ellsbury, Sungyoung Auh, Apurva Trivedi, Clara C. Chen, Marybeth Hughes, Stephen Wank
Gastrointestinal Endoscopy.2023;[Epub] CrossRef
Endoscopic full-thickness resection of well-differentiated T2 neuroendocrine tumors in the duodenal bulb: a case series
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Original Article

Efficacy of Precut Endoscopic Mucosal Resection for Treatment of Rectal Neuroendocrine Tumors: Hoonsub So, Su Hyun Yoo, Seungbong Han, Gwang-un Kim, Myeongsook Seo, Sung Wook Hwang, Dong-Hoon Yang, Jeong-Sik Byeon; Clin Endosc 2017;50(6):585-591. Published online October 12, 2017; DOI: https://doi.org/10.5946/ce.2017.039

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Background
/Aims: Endoscopic resection is the first-line treatment for rectal neuroendocrine tumors (NETs) measuring <1 cm and those between 1 and 2 cm in size. However, conventional endoscopic resection cannot achieve complete resection in all cases. We aimed to analyze clinical outcomes of precut endoscopic mucosal resection (EMR-P) used for the management of rectal NET.
Methods
EMR-P was used to treat rectal NET in 72 patients at a single tertiary center between 2011 and 2015. Both, circumferential precutting and EMR were performed with the same snare device in all patients. Demographics, procedural details, and histopathological features were reviewed for all cases.
Results
Mean size of the tumor measured endoscopically was 6.8±2.8 mm. En bloc and complete resection was achieved in 71 (98.6%) and 67 patients (93.1%), respectively. The mean time required for resection was 9.0±5.6 min. Immediate and delayed bleeding developed in six (8.3%) and 4 patients (5.6%), respectively. Immediate bleeding observed during EMR-P was associated with the risk of delayed bleeding.
Conclusions
Both, the en bloc and complete resection rates of EMR-P in the treatment of rectal NETs using the same snare for precutting and EMR were noted to be high. The procedure was short and safe. EMR-P may be a good treatment choice for the management of rectal NETs.

Citations

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Endoscopic mucosal resection using anchored snare Tip-in versus precut technique for small rectal neuroendocrine tumors
Seung Wook Hong, Dong-Hoon Yang, Yoo Jin Lee, Dong Hoon Baek, Jaeyoung Chun, Hyun Gun Kim, Sung Joo Kim, Seung-Mo Hong, Dae-Seong Myung
The Korean Journal of Internal Medicine.2024; 39(2): 238. CrossRef
Risk Factors for Lymph Node Metastasis and Oncologic Outcomes in Small Rectal Neuroendocrine Tumors with Lymphovascular Invasion
Seung-Joo Nam, Byung Chang Kim, Hee Jin Chang, Han Ho Jeon, Junho Kim, Su Young Kim
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EMR-P for small rectal neuroendocrine tumors: is it a preferred treatment?
Zhaohui Liu, Chunsi Zheng, Shihua Ding, Chong Chen, Jingbo Yang, Ruinuan Wu, Dayong Sun
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Recurrence after endoscopic resection of small rectal neuroendocrine tumors: a retrospective cohort study
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Giuseppe Iabichino, Milena Di Leo, Monica Arena, Giovanni Giuseppe Rubis Passoni, Elisabetta Morandi, Francesca Turpini, Paolo Viaggi, Carmelo Luigiano, Luca De Luca
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Comparison of conventional and modified endoscopic mucosal resection methods for the treatment of rectal neuroendocrine tumors
Hee Sung Lee, Hee Seok Moon, In Sun Kwon, Jae Ho Park, Ju Seok Kim, Sun Hyung Kang, Eaum Seok Lee, Seok Hyun Kim, Jae Kyu Sung, Byung Seok Lee, Hyun Yong Jeong
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Francesco Maione, Alessia Chini, Marco Milone, Nicola Gennarelli, Michele Manigrasso, Rosa Maione, Gianluca Cassese, Gianluca Pagano, Francesca Paola Tropeano, Gaetano Luglio, Giovanni Domenico De Palma
Diagnostics.2021; 11(5): 771. CrossRef
Anchoring the snare tip is a feasible endoscopic mucosal resection method for small rectal neuroendocrine tumors
Jeongseok Kim, Jisup Kim, Eun Hye Oh, Nam Seok Ham, Sung Wook Hwang, Sang Hyoung Park, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Seung-Mo Hong, Dong-Hoon Yang
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Incidental diagnosis of very small rectal neuroendocrine neoplasms: when should endoscopic submucosal dissection be performed? A single ENETS centre experience
Nico Pagano, Claudio Ricci, Nicole Brighi, Carlo Ingaldi, Francesco Pugliese, Donatella Santini, Davide Campana, Cristina Mosconi, Valentina Ambrosini, Riccardo Casadei
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BMC Gastroenterology.2018;[Epub] CrossRef
Proper Treatment Option for Small Rectal Neuroendocrine Tumors Using Precut Endoscopic Mucosal Resection
Seun Ja Park
Clinical Endoscopy.2017; 50(6): 516. CrossRef

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Case Reports

Synchronous Peripancreatic Lymph Node Gastrinoma and Gastric Neuroendocrine Tumor Type 2: Hee Woo Lee, Jun-Won Chung, Yoon Jae Kim, Kwang Ahn Kwon, Eui Joo Kim, Keon Kuk Kim, Woon Ki Lee, Sun Jin Sym; Clin Endosc 2016;49(5):483-487. Published online May 20, 2016; DOI: https://doi.org/10.5946/ce.2016.008

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A 34-year-old man was referred to our hospital with gastric polypoid lesions and biopsy-confirmed neuroendocrine tumor (NET). Computed tomography (CT) revealed a 3×3.5×8-cm retroperitoneal mass behind the pancreas, with multiple hepatic metastases. His serum gastrin level was elevated to 1,396 pg/mL. We performed a wedge resection of the stomach, a right hemi-hepatectomy, and a retroperitoneal mass excision. After careful review of the clinical, radiological, histopathological, and immunohistochemical findings, peripancreatic gastrinoma, and synchronous gastric NET were ultimately diagnosed. We reviewed a CT scan that had been performed 6 years previously after surgery for a duodenal perforation. There was no evidence of gastric or hepatic lesions, but the retroperitoneal mass was present at the same site. Had gastrinoma been detected earlier, our patient could have been cured using less invasive treatment. This case demonstrates how important it is to consider Zollinger-Ellison syndrome in patients with a recurrent or aggressive ulcer.

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Insights into Effects/Risks of Chronic Hypergastrinemia and Lifelong PPI Treatment in Man Based on Studies of Patients with Zollinger–Ellison Syndrome
Lingaku Lee, Irene Ramos-Alvarez, Tetsuhide Ito, Robert T. Jensen
International Journal of Molecular Sciences.2019; 20(20): 5128. CrossRef
Diagnosis of Zollinger–Ellison Syndrome in the Era of Ppis, Faulty Gastrin Assays, Sensitive Imaging and Limited Access to Acid Secretory Testing
David C Metz, Guillaume Cadiot, Pierre Poitras, Tetsuhide Ito, Robert T Jensen
International Journal of Endocrine Oncology.2017; 4(4): 167. CrossRef

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Multicentric Type 3 Gastric Neuroendocrine Tumors: Sang Hoon Lee, Dochang Moon, Hee Seung Lee, Choong-kun Lee, Yong Duk Jeon, Ji Hye Park, Hyunki Kim, Sang Kil Lee; Clin Endosc 2015;48(5):431-435. Published online September 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.5.431

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A 50-year-old woman with incidentally detected multiple gastric polyps and biopsy-proven neuroendocrine tumor (NET) was referred to our hospital. More than 10 polypoid lesions (less than 15 mm) with normal gastric mucosa were detected from the gastric body to the fundus. The serum level of gastrin was within the normal limits. There was no evidence of atrophic changes on endoscopy and serologic marker as pepsinogen I/II ratio. Computed tomography of the abdomen and pelvis revealed no evidence of metastatic lesions. She refused surgery, and we performed endoscopic polypectomy for almost all the gastric polyps that were greater than 5 mm. Although the histological examination revealed that all the removed polys were diagnosed as NET G1, three of them extended to the lateral or vertical resection margins, while two exhibited lymphovascular invasion. A follow-up upper endoscopy that was performed 6 months after the diagnosis showed multiple remnant gastric polyps that were suggestive of remnant gastric NET.

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Endoscopic Management of Gastro-Entero-Pancreatic Neuroendocrine Tumours: An Overview of Proposed Resection and Ablation Techniques
Rocio Chacchi-Cahuin, Edward J. Despott, Nikolaos Lazaridis, Alessandro Rimondi, Giuseppe Kito Fusai, Dalvinder Mandair, Andrea Anderloni, Valentina Sciola, Martyn Caplin, Christos Toumpanakis, Alberto Murino
Cancers.2024; 16(2): 352. CrossRef
Multimodal management of foregut neuroendocrine neoplasms
Yichan Zhou, James Weiquan Li, Noriya Uedo
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Clinicopathological features of primary gastric neuroendocrine neoplasms: A single‐center analysis
Tian Ming Xu, Chun Sai'er Wang, Cong Wei Jia, Jia Ming Qian, Jing Nan Li
Journal of Digestive Diseases.2016; 17(3): 162. CrossRef
A 15-year experience with gastric neuroendocrine tumors: Does type make a difference?
Lauren M. Postlewait, Gillian G. Baptiste, Cecilia G. Ethun, Nina Le, Kenneth Cardona, Maria C. Russell, Field F. Willingham, David A. Kooby, Charles A. Staley, Shishir K. Maithel
Journal of Surgical Oncology.2016; 114(5): 576. CrossRef

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Review

Diagnostic Coding for Intramucosal Carcinoma and Neuroendocrine Tumor in the Colorectum: Proposal for Avoiding Confusing Coding in Korea: Dong Soo Han, Jin Hee Sohn, Jeong-Sik Byeon, Hwang Choi, Joon Mee Kim; Clin Endosc 2015;48(3):216-220. Published online May 29, 2015; DOI: https://doi.org/10.5946/ce.2015.48.3.216

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Applying proper coding is important for doctors practicing gastroenterology. The coding systems established by various organizations define tumors differently. As a result of changing concepts of tumor classification, there are coding and reimbursement issues following the confirmation of malignant lesions by nationwide cancer screening in patients with intramucosal carcinoma and neuroendocrine tumors of the colorectum. In addition, there have been discrepancies between the views of endoscopists and pathologists regarding tumor coding. The Korean Society of Gastrointestinal Endoscopy held an expert meeting and established a consensus for the coding of intramucosal carcinoma and neuroendocrine tumor of the colorectum.

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Original Article

Endoscopic Ultrasonography-Guided Ethanol Ablation for Small Pancreatic Neuroendocrine Tumors: Results of a Pilot Study: Do Hyun Park, Jun-Ho Choi, Dongwook Oh, Sang Soo Lee, Dong-Wan Seo, Sung Koo Lee, Myung-Hwan Kim; Clin Endosc 2015;48(2):158-164. Published online March 27, 2015; DOI: https://doi.org/10.5946/ce.2015.48.2.158

Abstract PDF PubReader ePub

Background/Aims

Endoscopic ultrasonography (EUS)-guided ethanol ablation is gaining popularity for the treatment of focal pancreatic lesions. The aim of this study was to evaluate the safety, feasibility, and treatment response after EUS-guided ethanol injection for small pancreatic neuroendocrine tumors (p-NETs).

Methods

This was a retrospective analysis of a prospectively collected database including 11 consecutive patients with p-NETs who underwent EUS-guided ethanol injection.

Results

EUS-guided ethanol injection was successfully performed in 11 patients with 14 tumors. The final diagnosis was based on histology and clinical signs as follows: 10 non-functioning neuroendocrine tumors and four insulinomas. During follow-up (median, 370 days; range, 152 to 730 days), 10 patients underwent clinical follow-up after treatment, and one patient was excluded because of loss to follow-up. A single treatment session with an injection of 0.5 to 3.8 mL of ethanol resulted in complete responses (CRs) at the 3-month radiologic imaging for seven of 13 tumors (response rate, 53.8%). Multiple treatment sessions performed in three tumors with residual viable enhancing tissue increased the number of tumors with CRs to eight of 13 (response rate, 61.5%). Mild pancreatitis occurred in three of 11 patients.

Conclusions

EUS-guided ethanol injection appears to be a safe, feasible, and potentially effective method for treating small p-NETs in patients who are poor surgical candidates.

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Case Reports

Endoscopic Treatment of Duodenal Neuroendocrine Tumors: Sang Ho Kim, Chang Hwan Park, Ho Seok Ki, Chung Hwan Jun, Seon Young Park, Hyun Soo Kim, Sung Kyu Choi, Jong Sun Rew; Clin Endosc 2013;46(6):656-661. Published online November 19, 2013; DOI: https://doi.org/10.5946/ce.2013.46.6.656

Abstract PDF PubReader ePub

Duodenal neuroendocrine tumors (NETs) are rare neoplasms. In this study, the medical records of 14 patients with duodenal NETs diagnosed at Chonnam National University Hospital from July 2001 to August 2011 were reviewed and analyzed retrospectively. Four patients were diagnosed in the first 5 years, and 10 patients were diagnosed in the latter 5 years of the study. Ten of 12 patients (83.3%) who underwent endoscopic biopsy were confirmed to have NET before resection. Endoscopic resection was performed in 12 patients, surgical resection in one patient, and regular follow-up in one patient who refused resection. None of the patients showed recurrence or distant metastasis. Duodenal NETs are increasingly observed and are mostly detected during screening upper gastrointestinal endoscopy. Careful endoscopic examination and biopsy can improve the diagnostic yield of NETs. Most well-differentiated, nonfunctional duodenal NETs that are limited to the mucosa/submucosa can be treated effectively with endoscopic resection.

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Gastric Somatostatinoma: An Extremely Rare Cause of Upper Gastrointestinal Bleeding: Varayu Prachayakul, Pitulak Aswakul, Morakod Deesomsak, Ananya Pongpaibul; Clin Endosc 2013;46(5):582-585. Published online September 30, 2013; DOI: https://doi.org/10.5946/ce.2013.46.5.582

Abstract PDF PubReader ePub: A 49-year-old woman presented with chronic abdominal discomfort, significant weight loss, and chronic intermittent diarrhea. She suddenly developed massive upper gastrointestinal bleeding and was referred for further treatment. Endoscopy indicated a large mass in the upper gastric body with antral and duodenal bulb involvement. Endosonography showed a large well-defined isoechoic gastric subepithelial mass with multiple intra-abdominal and peripancreatic lymphadenopathy, suspected to be malignant on the basis of fine needle aspiration cytology. The tumor was surgically removed, and histopathology showed typical characteristics of a neuroendocrine tumor. On the basis of immunohistochemical staining, somatostatinoma, a rare neuroendocrine tumor, was diagnosed. Gastrointestinal bleeding is a rare presentation and the stomach is an uncommon tumor location.

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Special Issue Article of IDEN 2013

Endoscopic Treatment for Early Foregut Neuroendocrine Tumors: Moo In Park; Clin Endosc 2013;46(5):450-455. Published online September 30, 2013; DOI: https://doi.org/10.5946/ce.2013.46.5.450

Abstract PDF PubReader ePub

Foregut neuroendocrine tumors (NETs) include those arising in the esophagus, stomach, pancreas, and duodenum and seem to have a broad range of clinical behavior from benign to metastatic. Several factors including the advent of screening endoscopy may be related to increased incidence of gastrointestinal NETs; thus, many foregut NETs are diagnosed at an early stage. Early foregut NETs, such as those of the stomach and duodenum, can be managed with endoscopic treatment because of a low frequency of lymph node and distant metastases. However, controversy continues concerning the optimal management of early foregut NETs due to a lack of controlled prospective studies. Several issues such as indications, technical issues, and outcomes of endoscopic treatment for early foregut NETs are reviewed based on some published studies.

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