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. 2022 Oct;78(1):186-196.
doi: 10.1007/s12020-022-03143-3. Epub 2022 Jul 27.

Endoscopic surveillance alone is feasible and safe in type I gastric neuroendocrine neoplasms less than 10 mm in diameter

Klaire Exarchou #  1   2 , Haiyi Hu #  1   3 , Nathan A Stephens  2 , Andrew R Moore  4 , Mark Kelly  5 , Angela Lamarca  6   7 , Wasat Mansoor  6   7 , Richard Hubner  6   7 , Mairéad G McNamara  6   7 , Howard Smart  4 , Nathan R Howes  2 , Juan W Valle  6   7 , D Mark Pritchard  8   9
Affiliations

Endoscopic surveillance alone is feasible and safe in type I gastric neuroendocrine neoplasms less than 10 mm in diameter

Klaire Exarchou et al. Endocrine. 2022 Oct.

Abstract

Purpose: Type I gastric neuroendocrine neoplasms (g-NENs) have a low risk of metastasis and a generally favourable prognosis. Patients with small type I g-NENs (≤10 mm) frequently require no treatment, whereas those with larger polyps usually undergo resection. We evaluated the safety and outcomes of endoscopic surveillance after no initial treatment in selected patients with type I g-NENs.

Methods: Retrospective analysis of type I g-NEN patients across two European Neuroendocrine Tumour Society Centers of Excellence 2003-2019.

Results: Following initial assessment, 87 of 115 patients with type I g-NEN (75 with polyps ≤10 mm) received no initial treatment and underwent endoscopic surveillance. 79/87 (91%) demonstrated no clinically meaningful change in tumour size or grade over a median 62 month follow up. Only two patients developed NEN progression that required a change in management and two other patients developed gastric adenocarcinoma/high grade dysplasia; all four initially had ≥11 mm g-NENs.

Conclusions: Patients with ≤10 mm type I g-NENs were unlikely to develop clinically significant tumour progression and in most cases, resection was not needed. The endoscopic surveillance interval could therefore potentially be safely increased to every 2-3 years in such patients. However, lifelong surveillance is still advocated due to the additional risk of developing gastric adenocarcinoma.

Keywords: Carcinoid; Endoscopy; Neuroendocrine tumour; Stomach; Surgery; Surveillance.

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Conflict of interest statement

K.E. has received consultancy funding from Ipsen. A.R.M. has received consultancy funding from Ipsen. A.L. declares travel and educational support from Ipsen, Pfizer, Bayer, A.A.A., SirtEx, Novartis, Mylan and Delcath, speaker honoraria from Merck, Pfizer, Ipsen, Incyte, A.A.A., Q.E.D., Servier, Astra Zeneca and EISAI, advisory and consultancy honoraria from EISAI, Nutricia Ipsen, Q.E.D., Roche, Servier, Boston Scientific, Albireo Pharma, AstraZeneca, Boehringer Ingelheim and GENFIT, she is a member of the Knowledge Network and NETConnect Initiatives funded by Ipsen. WM has received consultancy funding from Ipsen, Novartis, Pfizer, Merck and B.M.S. Speakers’ Bureau. He has received travel grants from Merck and Ipsen as well as research funding from Nordic, M.S.D. R.H. has received consultancy funding from Ipsen and served on advisory boards for Ipsen. He has received conference attendance support. M.M.N. received research grant support from Servier, Ipsen, and NuCana. She has received travel and accommodation support from Bayer and Ipsen and speaker honoraria from Pfizer, Ipsen, NuCana, Mylan and Advanced Accelerator Applications (UK & Ireland) Ltd. She has served on advisory boards for Celgene, Ipsen, Sirtex, Baxalta, Incyte and Astra Zeneca; all outside of the scope of this work. J.W.V. reports personal fees from Agios, AstraZeneca, Baxter, Genoscience Pharma, Hutchison Medipharma, Imaging Equipment Ltd (AAA), Incyte, Ipsen, Mundipharma E.D.O., Mylan, Q.E.D., Servier, Sirtex, Zymeworks; and grants, personal fees, and non-financial support from NuCana, outside the submitted work. D.M.P. has received consultancy funding from Ipsen, Advanced Accelerator Applications and Mayoly Spindler laboratories and research funding from Trio Medicines Ltd. None of the other authors have any conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Flowchart of Type I g-NEN patient cohort according to management
Fig. 2
Fig. 2
Effect of type I gastric NEN size on patient prognosis. Kaplan–Meier curve demonstrating probability of a survival depending on size, b Intervention free survival depending on size and c rate of change depending on size
See this image and copyright information in PMC

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References

    1. Dasari A, et al. Trends in the incidence, prevalence, and survival outcomes in patients with neuroendocrine tumors in the United States. JAMA Oncol. 2017;3(10):1335–1342. doi: 10.1001/jamaoncol.2017.0589. - DOI - PMC - PubMed
    1. Yang Z, et al. Gastric Neuroendocrine Tumors (G-Nets): Incidence, prognosis and recent trend toward improved survival. Cell Physiol. Biochem. 2018;45(1):389–396. doi: 10.1159/000486915. - DOI - PubMed
    1. Lawrence B, et al. A clinical perspective on gastric neuroendocrine neoplasia. Curr. Gastroenterol. Rep. 2011;13(1):101–109. doi: 10.1007/s11894-010-0158-4. - DOI - PubMed
    1. Fave GD, et al. ENETS consensus guidelines update for gastroduodenal neuroendocrine neoplasms. Neuroendocrinology. 2016;103(2):119–124. doi: 10.1159/000443168. - DOI - PubMed
    1. Exarchou K, Howes N, Pritchard DM. Systematic review: Management of localised low-grade upper gastrointestinal neuroendocrine tumours. Aliment Pharm. Ther. 2020;51(12):1247–1267. doi: 10.1111/apt.15765. - DOI - PubMed

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