Endoscopy 2018; 50(04): S151
DOI: 10.1055/s-0038-1637489
ESGE Days 2018 ePosters
Georg Thieme Verlag KG Stuttgart · New York

DOUBLE-BALLOON ENTEROSCOPY IS USEFUL AND EFFECTIVE FOR THE DIAGNOSIS, ASSESSMENT AND MANAGEMENT OF SMALL BOWEL NEUROENDOCRINE TUMOURS: CASE SERIES FROM A NATIONAL TERTIARY REFERRAL CENTRE

A Telese
1   Institute for Liver and Digestive Health – University College London – School of Medicine, Royal Free Unit for Endoscopy – The Royal Free Hospital, London, United Kingdom
,
A Murino
1   Institute for Liver and Digestive Health – University College London – School of Medicine, Royal Free Unit for Endoscopy – The Royal Free Hospital, London, United Kingdom
,
E Phillips
2   Institute for Liver and Digestive Health – University College London – School of Medicine, Neuroendocrine Tumour Unit – The Royal Free Hospital, London, United Kingdom
,
F Laskaratos
2   Institute for Liver and Digestive Health – University College London – School of Medicine, Neuroendocrine Tumour Unit – The Royal Free Hospital, London, United Kingdom
,
TV Luong
3   Institute for Liver and Digestive Health – University College London – School of Medicine, Department of Cellular Pathology – The Royal Free Hospital -, London, United Kingdom
,
N Koukias
1   Institute for Liver and Digestive Health – University College London – School of Medicine, Royal Free Unit for Endoscopy – The Royal Free Hospital, London, United Kingdom
,
D Mandair
2   Institute for Liver and Digestive Health – University College London – School of Medicine, Neuroendocrine Tumour Unit – The Royal Free Hospital, London, United Kingdom
,
C Toumpanakis
2   Institute for Liver and Digestive Health – University College London – School of Medicine, Neuroendocrine Tumour Unit – The Royal Free Hospital, London, United Kingdom
,
ME Caplin
2   Institute for Liver and Digestive Health – University College London – School of Medicine, Neuroendocrine Tumour Unit – The Royal Free Hospital, London, United Kingdom
,
EJ Despott
1   Institute for Liver and Digestive Health – University College London – School of Medicine, Royal Free Unit for Endoscopy – The Royal Free Hospital, London, United Kingdom
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Background:

Although small bowel (SB) neuroendocrine tumours (SBNETs) often present as indolent lesions, late diagnosis may result in poor outcomes. Successful management is therefore dependent on early identification. Double-balloon enteroscopy (DBE) enables direct SB mucosal visualisation, sampling and endotherapy. Our aim was to evaluate the role of DBE for early diagnosis and management of SBNETs.

Methods:

Retrospective review of all SBNETs diagnosed/evaluated by DBE at our institution (November 2016-July 2017). Demographic, endoscopic, histopathological and follow-up data were collated/analyzed.

Results:

A total of 5 patients were included (mean age: 49 (SD ± 13.2) years; male/female ratio: 1.5). All patients presented with obscure-overt mid-gut bleeding (OOGIB) (n = 3) or iron deficiency anaemia (n = 2). A total of 6 SBNETs were identified in the 5 patients at DBE. Dedicated SB radiological imaging was performed in 4 patients and this showed a potential primary lesion in 3 cases. At DBE, identified lesions were marked with a submucosal tattoo of sterile India ink and histopathology of lesion biopsies was diagnostic of SBNETs in all 5 patients. Four patients underwent minimally-invasive oncological SB resection (mean resection length: 33.7 (SD ± 14.4)cm); marking tattoos placed at DBE, successfully guided surgery in all 4 cases; the remaining patient awaits resection. The final number of SBNETs identified at surgery was 12 (average dimension: 7.2 (SD ± 3.0)mm; mean number/patient: 3 (SD ± 1.8)). Histopathological evaluation: Well-differentiated grade 1 SBNET (n = 10; 83.3%), well-differentiated grade 2 SBNET (n = 2; 16.6%). The largest tumour (diameter: 15 mm), a well differentiated grade 2 NET was not identified by Gallium-68 PETCT scanning during staging/assessment.

Conclusion:

DBE is an essential procedure for early diagnosis and pre-surgical assessment of SBNETs. The role of DBE also extends to localization and marking which may be used to guide minimally-invasive surgical resection.