Endoscopic full-thickness resection of duodenal neuroendocrine tumors using the Full-Thickness Resection Device (FTRD): Results from a large, retrospective, multicenter study

Aims Duodenal neuroendocrine tumors (dNET) are rare tumors of the small intestine and are often found as an incidental finding of a subepithelial lesion during endoscopy. The Full-Thickness Resection Device (FTRD) enables endoscopic full-thickness resection of epithelial and subepithelial lesions. Endoscopic mucosa resection (EMR) has a low R0 resection rate for this indication, while endoscopic submucosal dissection (ESD) is associated with a higher rate of adverse events.

Methods As part of an international, multicenter study, patients who underwent FTRD resection of dNET were retrospectively identified at 35 centers. Endpoints were rates of technically successful resections, R0 resections and adverse events.

Results 165 cases were identified at 35 centers. The median age was 64 years (range: 24 – 86) and 70 patients (41.4%) were female. The target lesion was in the duodenal bulb in 142 cases (84.0%), in the descending part in 25 cases (14.8%), and in the horizontal part and ascending part in one case each (0.6%). Median size of the lesion on endoscopic ultrasound was 10 mm (range: 4 – 22). Prior endoscopic treatment had been performed in 35 cases (20.7%). Gastroduodenal FTRD was used in 164 cases (97.0%). The lesion was reached with the FTRD in 165 cases (97.6%) cases. In three cases it was not possible to pull the lesion into the cap and thus resection was successful in 162 cases (95.9%). Median procedure time was 43 minutes. Histologically, an R0 resection was present in 120 cases (71.0%), an incomplete resection was found in 33 (19.5%) and completeness of resection could not be assessed (Rx) in 11 cases. During follow-up there was no recurrence among these eleven cases. Total rate of recurrence was 3.0% (n=5 cases). An intraprocedural adverse event occurred in nine cases (5.3%). Among them were five events of bleeding, that were treated endoscopically and classified as mild, and four perforations, which were treated by endoscopy and surgery in two cases each. Postinterventional adverse events occurred in 23 patients (13.6%), which included 12 events of bleeding. All patients were treated endoscopically and only one event was classified as severe due to an ICU admission. Other adverse events included pain (n=3), duodenal obstruction (n=4), liver abscess>30 days after the procedure (n=1) and other (n=3). Only three of all adverse events were classified as severe (1.8%).

Conclusions Resection of dNET using endoscopic full-thickness resection with FTRD showed a high rate of technical success, an acceptable R0 resection rate, very low rate of recurrence and a low rate of severe adverse events. It thus seems preferable over EMR or ESD for endoscopic resection of dNET.

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Artikel online veröffentlicht:
15. April 2024