Treatment Results of Endoscopic Mucosal Resection with a Ligation Device for Duodenal Neuroendocrine Tumors

Ai Fujimoto, Motoki Sasaki, Osamu Goto, Tadateru Maehata, Yasutoshi Ochiai, Motohiko Kato, Atsushi Nakayama, Teppei Akimoto, Jyunko Kuramoto, Yuichiro Hayashi, Kaori Kameyama, Naohisa Yahagi

Research output: Contribution to journalArticle

Abstract

Objective The vertical margin of neuroendocrine tumors (NETs) removed by endoscopic mucosal resection (EMR) is often tumor-positive. We examine the treatment results of endoscopic mucosal resection with a ligation device (EMR-L) for the removal of duodenal NETs located in the submucosal layer without metastasis. EMR-L can be performed with less technical skill, and the ligation device reduces the rate of positive vertical margin. Methods Ten consecutive patients with 10 duodenal NETs resected by EMR-L were enrolled. All of the lesions were located in the submucosal layer, were assessed to be free of metastasis, and were confirmed to be NETs pathologically by an endoscopic biopsy. The endoscopic results, pathological results, and prognosis were all examined. Results The en bloc resection rate and endoscopic complete resection rate were both 100%. Complete resection was achieved pathologically in 7 lesions (70.0%). The vertical margins were negative in all cases. Lymphatic vessel invasion was observed in three patients, all of whom underwent additional surgery with lymph node dissection (one of them also exhibited blood vessel invasion and a positive horizontal margin). No evidence of residual tumors or lymph node metastasis was observed in any of the patients. No recurrence was observed in any of the 10 patients (mean follow-up period: 18.6 months). One patient (10.0%) experienced intraoperative bleeding. Perforation occurred in 1 patient (10.0%), but the condition was managed well by conservative therapy. Conclusion EMR-L was an acceptable method for endoscopically resecting submucosal duodenal NETs, and the NETs resected by EMR-L were tumor-negative in the vertical margins.

Original languageEnglish
Pages (from-to)773-777
Number of pages5
JournalInternal medicine (Tokyo, Japan)
Volume58
Issue number6
DOIs
Publication statusPublished - 2019 Mar 15

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Neuroendocrine Tumors
Ligation
Equipment and Supplies
Neoplasm Metastasis
Therapeutics
Lymphatic Vessels
Residual Neoplasm
Endoscopic Mucosal Resection
Lymph Node Excision
Blood Vessels
Neoplasms
Lymph Nodes
Hemorrhage
Biopsy
Recurrence

Keywords

  • duodenal neuroendocrine tumor
  • endoscopic mucosal resection with a ligation device
  • treatment results
  • vertical margin

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Treatment Results of Endoscopic Mucosal Resection with a Ligation Device for Duodenal Neuroendocrine Tumors. / Fujimoto, Ai; Sasaki, Motoki; Goto, Osamu; Maehata, Tadateru; Ochiai, Yasutoshi; Kato, Motohiko; Nakayama, Atsushi; Akimoto, Teppei; Kuramoto, Jyunko; Hayashi, Yuichiro; Kameyama, Kaori; Yahagi, Naohisa.

In: Internal medicine (Tokyo, Japan), Vol. 58, No. 6, 15.03.2019, p. 773-777.

Research output: Contribution to journalArticle

Fujimoto, Ai ; Sasaki, Motoki ; Goto, Osamu ; Maehata, Tadateru ; Ochiai, Yasutoshi ; Kato, Motohiko ; Nakayama, Atsushi ; Akimoto, Teppei ; Kuramoto, Jyunko ; Hayashi, Yuichiro ; Kameyama, Kaori ; Yahagi, Naohisa. / Treatment Results of Endoscopic Mucosal Resection with a Ligation Device for Duodenal Neuroendocrine Tumors. In: Internal medicine (Tokyo, Japan). 2019 ; Vol. 58, No. 6. pp. 773-777.
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abstract = "Objective The vertical margin of neuroendocrine tumors (NETs) removed by endoscopic mucosal resection (EMR) is often tumor-positive. We examine the treatment results of endoscopic mucosal resection with a ligation device (EMR-L) for the removal of duodenal NETs located in the submucosal layer without metastasis. EMR-L can be performed with less technical skill, and the ligation device reduces the rate of positive vertical margin. Methods Ten consecutive patients with 10 duodenal NETs resected by EMR-L were enrolled. All of the lesions were located in the submucosal layer, were assessed to be free of metastasis, and were confirmed to be NETs pathologically by an endoscopic biopsy. The endoscopic results, pathological results, and prognosis were all examined. Results The en bloc resection rate and endoscopic complete resection rate were both 100{\%}. Complete resection was achieved pathologically in 7 lesions (70.0{\%}). The vertical margins were negative in all cases. Lymphatic vessel invasion was observed in three patients, all of whom underwent additional surgery with lymph node dissection (one of them also exhibited blood vessel invasion and a positive horizontal margin). No evidence of residual tumors or lymph node metastasis was observed in any of the patients. No recurrence was observed in any of the 10 patients (mean follow-up period: 18.6 months). One patient (10.0{\%}) experienced intraoperative bleeding. Perforation occurred in 1 patient (10.0{\%}), but the condition was managed well by conservative therapy. Conclusion EMR-L was an acceptable method for endoscopically resecting submucosal duodenal NETs, and the NETs resected by EMR-L were tumor-negative in the vertical margins.",
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T1 - Treatment Results of Endoscopic Mucosal Resection with a Ligation Device for Duodenal Neuroendocrine Tumors

AU - Fujimoto, Ai

AU - Sasaki, Motoki

AU - Goto, Osamu

AU - Maehata, Tadateru

AU - Ochiai, Yasutoshi

AU - Kato, Motohiko

AU - Nakayama, Atsushi

AU - Akimoto, Teppei

AU - Kuramoto, Jyunko

AU - Hayashi, Yuichiro

AU - Kameyama, Kaori

AU - Yahagi, Naohisa

PY - 2019/3/15

Y1 - 2019/3/15

N2 - Objective The vertical margin of neuroendocrine tumors (NETs) removed by endoscopic mucosal resection (EMR) is often tumor-positive. We examine the treatment results of endoscopic mucosal resection with a ligation device (EMR-L) for the removal of duodenal NETs located in the submucosal layer without metastasis. EMR-L can be performed with less technical skill, and the ligation device reduces the rate of positive vertical margin. Methods Ten consecutive patients with 10 duodenal NETs resected by EMR-L were enrolled. All of the lesions were located in the submucosal layer, were assessed to be free of metastasis, and were confirmed to be NETs pathologically by an endoscopic biopsy. The endoscopic results, pathological results, and prognosis were all examined. Results The en bloc resection rate and endoscopic complete resection rate were both 100%. Complete resection was achieved pathologically in 7 lesions (70.0%). The vertical margins were negative in all cases. Lymphatic vessel invasion was observed in three patients, all of whom underwent additional surgery with lymph node dissection (one of them also exhibited blood vessel invasion and a positive horizontal margin). No evidence of residual tumors or lymph node metastasis was observed in any of the patients. No recurrence was observed in any of the 10 patients (mean follow-up period: 18.6 months). One patient (10.0%) experienced intraoperative bleeding. Perforation occurred in 1 patient (10.0%), but the condition was managed well by conservative therapy. Conclusion EMR-L was an acceptable method for endoscopically resecting submucosal duodenal NETs, and the NETs resected by EMR-L were tumor-negative in the vertical margins.

AB - Objective The vertical margin of neuroendocrine tumors (NETs) removed by endoscopic mucosal resection (EMR) is often tumor-positive. We examine the treatment results of endoscopic mucosal resection with a ligation device (EMR-L) for the removal of duodenal NETs located in the submucosal layer without metastasis. EMR-L can be performed with less technical skill, and the ligation device reduces the rate of positive vertical margin. Methods Ten consecutive patients with 10 duodenal NETs resected by EMR-L were enrolled. All of the lesions were located in the submucosal layer, were assessed to be free of metastasis, and were confirmed to be NETs pathologically by an endoscopic biopsy. The endoscopic results, pathological results, and prognosis were all examined. Results The en bloc resection rate and endoscopic complete resection rate were both 100%. Complete resection was achieved pathologically in 7 lesions (70.0%). The vertical margins were negative in all cases. Lymphatic vessel invasion was observed in three patients, all of whom underwent additional surgery with lymph node dissection (one of them also exhibited blood vessel invasion and a positive horizontal margin). No evidence of residual tumors or lymph node metastasis was observed in any of the patients. No recurrence was observed in any of the 10 patients (mean follow-up period: 18.6 months). One patient (10.0%) experienced intraoperative bleeding. Perforation occurred in 1 patient (10.0%), but the condition was managed well by conservative therapy. Conclusion EMR-L was an acceptable method for endoscopically resecting submucosal duodenal NETs, and the NETs resected by EMR-L were tumor-negative in the vertical margins.

KW - duodenal neuroendocrine tumor

KW - endoscopic mucosal resection with a ligation device

KW - treatment results

KW - vertical margin

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