Selective Resection of Type 1 Gastric Neuroendocrine Neoplasms and the Risk of Progression in an Endoscopic Surveillance Programme.
Endoscopic surveillance
Gastric carcinoids
Gastric neuroendocrine tumour
Type 1 gastric neuroendocrine neoplasms
Journal
Digestive surgery
ISSN: 1421-9883
Titre abrégé: Dig Surg
Pays: Switzerland
ID NLM: 8501808
Informations de publication
Date de publication:
2021
2021
Historique:
received:
28
03
2020
accepted:
17
08
2020
pubmed:
2
12
2020
medline:
16
10
2021
entrez:
1
12
2020
Statut:
ppublish
Résumé
Current guidance for type 1 gastric neuroendocrine neoplasms (gNENs) recommends either resection of all visible lesions or selective resection of gNENs >10 mm. We adopt a selective strategy targeting lesions approaching 10 mm for endoscopic mucosal resection (EMR) and provide surveillance for smaller lesions. This study aimed to describe the incidence of type 1 gNENs requiring endoscopic/surgical resection and the risk of disease progression (both considered significant disease) on endoscopic surveillance. The secondary objective was to assess the risk factors for disease progression during surveillance and the incidence of gastric dysplasia/adenoma/adenocarcinoma. We collected consecutive patients with type 1 gNENs and obtained demographic and clinical data through the electronic patient record. In our cohort of 57 patients, 12 patients had EMR at index gastroscopy; 7 patients had surgery (4: large/multiple gNENs and 3: nodal metastases) (5.2% [3/57] risk of nodal metastases); and a patient with nodal and liver metastases (1.8% [1/57] risk of distant metastases). The prevalence of gastric adenocarcinoma in our study was 3.5% with an incidence rate of 9.59 per 1,000 persons per year. For patients undergoing surveillance, 29.5% (13/44) of patients progressed requiring resection. Serum gastrin was significantly higher in patients who progressed to resection (p value = 0.023). We concluded that up to a third of patients with type 1 gNENs have significant disease requiring resection. Hence, endoscopic surveillance and resect strategy would benefit patients.
Sections du résumé
BACKGROUND
BACKGROUND
Current guidance for type 1 gastric neuroendocrine neoplasms (gNENs) recommends either resection of all visible lesions or selective resection of gNENs >10 mm. We adopt a selective strategy targeting lesions approaching 10 mm for endoscopic mucosal resection (EMR) and provide surveillance for smaller lesions.
OBJECTIVES
OBJECTIVE
This study aimed to describe the incidence of type 1 gNENs requiring endoscopic/surgical resection and the risk of disease progression (both considered significant disease) on endoscopic surveillance. The secondary objective was to assess the risk factors for disease progression during surveillance and the incidence of gastric dysplasia/adenoma/adenocarcinoma.
METHODS
METHODS
We collected consecutive patients with type 1 gNENs and obtained demographic and clinical data through the electronic patient record.
RESULTS
RESULTS
In our cohort of 57 patients, 12 patients had EMR at index gastroscopy; 7 patients had surgery (4: large/multiple gNENs and 3: nodal metastases) (5.2% [3/57] risk of nodal metastases); and a patient with nodal and liver metastases (1.8% [1/57] risk of distant metastases). The prevalence of gastric adenocarcinoma in our study was 3.5% with an incidence rate of 9.59 per 1,000 persons per year. For patients undergoing surveillance, 29.5% (13/44) of patients progressed requiring resection. Serum gastrin was significantly higher in patients who progressed to resection (p value = 0.023).
CONCLUSION
CONCLUSIONS
We concluded that up to a third of patients with type 1 gNENs have significant disease requiring resection. Hence, endoscopic surveillance and resect strategy would benefit patients.
Identifiants
pubmed: 33260173
pii: 000510962
doi: 10.1159/000510962
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
38-45Informations de copyright
© 2020 S. Karger AG, Basel.