The Clinial Value Of Endoscopic Diagnosis And Treatment In Upper Gastrointestinal Neuroendocrine Tumors

Objective:To evaluate the feasibility and efficacy of endoscopic ultrasound (EUS) and endoscopic submucosal dissection (ESD) for upper gastrointestinal(GI) neuroendocrine neoplasm(NENs).Methods:We conducted a retrospective review of 26 cases of upper GI NENs treated with ESD between August 2010 and January 2014 at the First Affiliated Hospital of Zhejiang University and Yinzhou Hospital Affiliated to Medical School of Ningbo University. The medical records of tumor features, pathological characteristics, complete resection rates, complications and follow-up results were collected.Results:31 NENs from 26 patients were included in present study and EUS results showed that 18 of them grew in muscularis mucosa and the rest were from submucosa. The en bloc resection for the lesions was performed by ESD. Two of the lesions were located in esophagus,24 in stomach and 5 in duodenal bulb. The average maximum diameter of the lesions was 10.3(3-35) mm, and the average procedure time was 37.3(15-65) min. Complete resection rate was 93.5%(29/31). One patient with NET-G2 in stomach underwent an additional ESD and 1 patient with NET-G1 in duodenal bulb was treated by argon plasma coagulation after rejecting a surgery or ESD. Histological evaluation indicated that 27 lesions were NET-G1,3 gastric lesions were NET-G2, and 1 esophageal lesion was NET-G2.These patients did not undergo any delayed bleeding or perforation after ESD. Two of them were lost to follow-up. The mean follow-up period is 20.6 months (10-41 months). Local recurrence occurred in only 1 patient who underwent a secondary ESD for complete resection successfully. Metastasis to lymph, nodes, blood vessel or distal organs was not observed.Conclusion:EUS is able to identify the origins of upper GI NENs and improve its endoscopic diagnosis and treatment. ESD appears to be a safe and effective way for treating upper GI NENs located in submucosa.