Jun Liong Chin1,2, Jim O'Connell3, Cian Muldoon3, Niall Swan4, John Vincent Reynolds3, Narayanasamy Ravi3, Justin Geoghegan4, Kevin C Conlon4,5, Donal O'Shea4, Dermot O'Toole4,3. 1. ENETS Neuroendocrine Tumour Centre of Excellence, St. Vincent's University Hospital, University College, Dublin, Ireland, junliong@hotmail.com. 2. St. James's Hospital, Trinity College, Dublin, Ireland, junliong@hotmail.com. 3. St. James's Hospital, Trinity College, Dublin, Ireland. 4. ENETS Neuroendocrine Tumour Centre of Excellence, St. Vincent's University Hospital, University College, Dublin, Ireland. 5. Tallaght Hospital, Trinity College, Dublin, Ireland.
Abstract
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: 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: We collected consecutive patients with type 1 gNENs and obtained demographic and clinical data through the electronic patient record. 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: 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.
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: 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: We collected consecutive patients with type 1 gNENs and obtained demographic and clinical data through the electronic patient record. 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: 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.
Authors: Francesco Panzuto; Ludovica Magi; Gianluca Esposito; Maria Rinzivillo; Bruno Annibale Journal: Gastroenterol Res Pract Date: 2021-03-30 Impact factor: 2.260
Authors: Klaire Exarchou; Haiyi Hu; Nathan A Stephens; Andrew R Moore; Mark Kelly; Angela Lamarca; Wasat Mansoor; Richard Hubner; Mairéad G McNamara; Howard Smart; Nathan R Howes; Juan W Valle; D Mark Pritchard Journal: Endocrine Date: 2022-07-27 Impact factor: 3.925
Authors: Klaire Exarchou; Nathan A Stephens; Andrew R Moore; Nathan R Howes; D Mark Pritchard Journal: Curr Oncol Rep Date: 2022-01-20 Impact factor: 5.075