ENDOSCOPIC SUBMUCOSAL DISSECTION FOR GASTROINTESTINAL NEUROENDOCRINE TUMORS: A BICENTRIC PROSPECTIVELY COLLECTED WESTERN PRELIMINARY EXPERIENCE

Aims:

Selected gastrointestinal (GI) neuroendocrine tumors (NETs) are suitable for endoscopic submucosal dissection (ESD) but its efficacy and safety in western countries are limited. The aim of this study is to review two European centers experience of endoscopic treatment of superficial GI NET by ESD.

Methods:

Clinical and technical data of patients treated by ESD from two tertiary European centers were prospectively collected from October 2014 to November 2018. Complete resection (R0) was defined as clear lateral and vertical margins.

Results:

Twenty-three ESDs of NET were performed in 21 patients (males 38%, mean age of 56 years. The majority of the lesions were located in the stomach (68%) followed by the rectum (26%), esophagus (4%) and duodenum (4%). For gastric NETs, 87% were associated to atrophic gastritis and 53% to previous history of multiples NETs. Complete endoscopic resection by en-bloc resection was achieved in all patients (100%). R0 resection rate was 71% (91% clear lateral and 73% clear vertical margins).

Median ESD duration time was of 60 min (20 – 240). Two cases presented small perforations, treated conservatively by antibiotics and clip closure. The median specimen size was of 25 (12 – 50)mm. Pathological examination showed 56% grade 1 NETs, 36% grade 2 and 4% grade 3. Fifteen lesions were characterized as pT1 (75%). Three patients were candidates for additional treatment: one received EMR for additional known lesions, one underwent surgery with oncological lymph node resection (finally pT2N1) and the one refused systemic therapy. Two cases of recurrence were identified at the end of a median follow-up of 18 months: one was managed endoscopically while the second refused treatment.

Conclusions:

Our series of ESD for selected GI NETs showed favorable results in term of efficacy and safety. However, further studies are needed to determine the role of ESD compared to other resection modalities.