ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) OF GASTRIC AND RECTAL NEUROENDOCRINE TUMOURS (NETS): A CASE SERIES FROM A TERTIARY REFERRAL CENTRE (WITH VIDEO)

Background:

Gastrointestinal (GI) neuroendocrine tumours (NETs) are potentially malignant lesions originating from GI neuroendocrine cells. Endoscopic submucosal dissection (ESD) is an advanced, complex endoscopic technique developed in Japan, which allows for en-bloc resection of mucosal and submucosal lesions.

Aim:

To assess the effectiveness and safety of ESD for the management of gastric and rectal NETs.

Method:

Retrospective review of GI NETs resected by ESD at our institution between October 2014 and February 2017. Demographic, endoscopic, histopathological and follow-up data were collected and analysed.

Result:

Six ESDs were performed in 5 patients (all women, mean age 57.8 ± 12.1 years). Five NETs were located in the stomach (83%) and 1 in the rectum (17%). Mean lesion diameter was 14 mm ± 2.2 mm. Histopathological analysis showed 3 (50%) well-differentiated grade G1 NETs and 3 (50%) well-differentiated grade G2 NETs. R0 resection was obtained in 5 lesions (83%) while R1 resection was encountered in only 1 case (17%). Microvascular invasion was observed in l case (13%) of a gastric G2 NET but the patient did not require any further treatment. Deep muscle injury occurred in only 1 case and was managed successfully with prophylactic endoscopic clipping. No significant adverse events (i.e. perforation, bleeding, sepsis or need for surgery) were observed. At > 3 months follow-up (range: 28 – 5 months, mean follow-up 21.7 months) all 4 patients with R0 resections have shown no evidence of recurrence.

Conclusion:

ESD appears to be an effective, minimally invasive and safe alternative to major surgery for resection of gastric and rectal NETs.