International, Multicenter Analysis of Endoscopic Full-Thickness Resection of Duodenal Neuroendocrine Tumors

Andreas Wannhoff¹, Zaheer Nabi², Leon M G Moons³, Gregory Haber⁴, Phillip S Ge⁵, Tobias Dertmann⁶, Pierre H Deprez⁷, Wojciech Korcz⁸, Christopher Bouvette⁹, Julius Mueller¹⁰, George Tribonias¹¹, Giuseppe Grande¹², John J Kim^{13

14}, Alexander Weich^{15

16}, Henriette Heinrich¹⁷, Matthias Mollenkopf¹, Jeffey George¹⁸, Mathieu Pioche¹⁹, Francesco Azzolini²⁰, Konstantinos Kouladouros^{21

22}, Phil Boger²³, Bu'Hussain Hayee²⁴, Mohammad Bilal²⁵, Barbara A J Bastiaansen²⁶, Karel Caca¹; Upper GI FTRD Study Group

Collaborators, Affiliations

Collaborators

Affiliations

¹ Department of Internal Medicine, Gastroenterology, Haemato-Oncology, Diabetology, and Infectiology, RKH Klinikum Ludwigsburg, Ludwigsburg, Germany.
² Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.
³ Gastroenterology and Hepatology, UMC Utrecht, Utrecht, the Netherlands.
⁴ Division of Gastroenterology, NYU Langone Health, New York, New York, USA.
⁵ Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
⁶ Clinic for Internal Medicine and Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany.
⁷ Hepato-Gastroenterology Department, Cliniques univ St-Luc, Univ catholique de Louvain, Brussels, Belgium.
⁸ Department of Gastroenterological Oncology, The Maria-Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.
⁹ Section of Digestive Diseases and Nutrition, Department of Medicine, OU Health, Oklahoma City, Oklahoma, USA.
¹⁰ Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
¹¹ Department of Gastroenterology, General Hospital of Nikaia-Piraeus Agios Panteleimon, Athens, Greece.
¹² Gastroenterology and Digestive Endoscopy, Azienda Ospedaliero Universitaria of Modena, Modena, Italy.
¹³ Division of Gastroenterology and Hepatology, Loma Linda University Health, Loma Linda, California, USA.
¹⁴ Division of Gastroenterology and Hepatology, Los Angeles General Medical Center, Los Angeles, California, USA.
¹⁵ Department of Gastroenterology, University Hospital of Würzburg, Würzburg, Germany.
¹⁶ Zentrum für neuroendokrine Tumoren Würzburg (ENETS CoE), University Hospital Würzburg, Würzburg, Germany.
¹⁷ Clarunis Universitäres Bauchzentrum Basel, Abteilung für Gastroenterologie und Hepatologie, Universitätsspital Basel, Basel, Switzerland.
¹⁸ Department of Gastroenterology, Aster Medcity, Kochi, India.
¹⁹ Hepatogastroenterology, Hospices Civils de Lyon, Lyon, France.
²⁰ Department of Gastroenterology, San Raffaele Hospital, Milano, Italy.
²¹ Central Interdisciplinary Endoscopy, Universitätsklinikum Mannheim, Mannheim, Germany.
²² Central Inderdisciplinary Endoscopy, Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Berlin, Germany.
²³ Departement of Gastroenterology, University Hospital Southampton, Southampton, UK.
²⁴ King's Institute of Therapeutic Endoscopy, King's College Hospital, London, UK.
²⁵ Gastroenterology and Hepatology, Minneapolis VA Medical Center, Minneapolis, Minnesota, USA.
²⁶ Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, the Netherlands.

PMID: 40079474
DOI: 10.14309/ajg.0000000000003409

International, Multicenter Analysis of Endoscopic Full-Thickness Resection of Duodenal Neuroendocrine Tumors

Andreas Wannhoff et al. Am J Gastroenterol. 2025.

. 2025 Mar 13.

doi: 10.14309/ajg.0000000000003409. Online ahead of print.

Authors

Collaborators

Affiliations

¹ Department of Internal Medicine, Gastroenterology, Haemato-Oncology, Diabetology, and Infectiology, RKH Klinikum Ludwigsburg, Ludwigsburg, Germany.
² Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.
³ Gastroenterology and Hepatology, UMC Utrecht, Utrecht, the Netherlands.
⁴ Division of Gastroenterology, NYU Langone Health, New York, New York, USA.
⁵ Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
⁶ Clinic for Internal Medicine and Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany.
⁷ Hepato-Gastroenterology Department, Cliniques univ St-Luc, Univ catholique de Louvain, Brussels, Belgium.
⁸ Department of Gastroenterological Oncology, The Maria-Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.
⁹ Section of Digestive Diseases and Nutrition, Department of Medicine, OU Health, Oklahoma City, Oklahoma, USA.
¹⁰ Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
¹¹ Department of Gastroenterology, General Hospital of Nikaia-Piraeus Agios Panteleimon, Athens, Greece.
¹² Gastroenterology and Digestive Endoscopy, Azienda Ospedaliero Universitaria of Modena, Modena, Italy.
¹³ Division of Gastroenterology and Hepatology, Loma Linda University Health, Loma Linda, California, USA.
¹⁴ Division of Gastroenterology and Hepatology, Los Angeles General Medical Center, Los Angeles, California, USA.
¹⁵ Department of Gastroenterology, University Hospital of Würzburg, Würzburg, Germany.
¹⁶ Zentrum für neuroendokrine Tumoren Würzburg (ENETS CoE), University Hospital Würzburg, Würzburg, Germany.
¹⁷ Clarunis Universitäres Bauchzentrum Basel, Abteilung für Gastroenterologie und Hepatologie, Universitätsspital Basel, Basel, Switzerland.
¹⁸ Department of Gastroenterology, Aster Medcity, Kochi, India.
¹⁹ Hepatogastroenterology, Hospices Civils de Lyon, Lyon, France.
²⁰ Department of Gastroenterology, San Raffaele Hospital, Milano, Italy.
²¹ Central Interdisciplinary Endoscopy, Universitätsklinikum Mannheim, Mannheim, Germany.
²² Central Inderdisciplinary Endoscopy, Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Berlin, Germany.
²³ Departement of Gastroenterology, University Hospital Southampton, Southampton, UK.
²⁴ King's Institute of Therapeutic Endoscopy, King's College Hospital, London, UK.
²⁵ Gastroenterology and Hepatology, Minneapolis VA Medical Center, Minneapolis, Minnesota, USA.
²⁶ Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, the Netherlands.

PMID: 40079474
DOI: 10.14309/ajg.0000000000003409

Abstract

Introduction: Nonexposed endoscopic full-thickness resection (EFTR) using a dedicated full-thickness resection device can be used to perform en bloc resection of subepithelial lesions throughout the gastrointestinal tract. In this article, we aim to evaluate the safety and efficacy of EFTR for the management of duodenal neuroendocrine tumors (dNETs).

Methods: This was an international multicenter retrospective study of device-assisted EFTR for dNET. Study outcomes included rates of technical success, R0 resection, and adverse events (AEs).

Results: A total of 171 patients were included across 35 centers. Lesions had a median size of 10 mm and were in the duodenal bulb in 143 cases (83.6%). Technical success was achieved in 164 (95.9%) and R0 resection in 123 cases (71.9%). The R0 resection rate for lesions located in the proximal third of the bulb was 62.0% compared with 83.9% for more distal locations ( P = 0.002). The R0 resection rate was not affected by lesion size or depth of invasion. On multivariable analysis, date of resection (2021 onward) and location distal to the proximal third of the duodenal bulb were independent predictors of R0 resection, but not case volume per participating center. Follow-up information was available for 114 patients (66.7%) and demonstrated 2 recurrences over a median follow-up of 10 months. Severe AEs occurred in 3 patients (1.8%).

Discussion: EFTR of dNET showed high technical success and R0 resection rates and very low rate of severe AEs. It could become endoscopic treatment of choice for dNET, at least for lesions not within proximity of the pylorus.

Keywords: duodenal neuroendocrine tumor; endoscopic full-thickness resection; endoscopic mucosal resection; neuroendocrine neoplasm.

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References

1. Panzuto F, Ramage J, Pritchard DM, et al. European Neuroendocrine Tumor Society (ENETS) 2023 guidance paper for gastroduodenal neuroendocrine tumours (NETs) G1–G3. J Neuroendocrinol 2023;35(8):e13306.
1. Milione M, Parente P, Grillo F, et al. Neuroendocrine neoplasms of the duodenum, ampullary region, jejunum and ileum. Pathologica 2021;113(1):12–8.
1. Kim GH, Kim JI, Jeon SW, et al. Endoscopic resection for duodenal carcinoid tumors: A multicenter, retrospective study. J Gastroenterol Hepatol 2014;29(2):318–24.
1. Wang Y, Ren Z, Shen YH, et al. Long-term outcomes of endoscopic resection for well-differentiated nonampullary duodenal neuroendocrine tumors. Gastrointest Endosc 2024;100(3):481–91.e6.
1. Panzuto F, Parodi MC, Esposito G, et al. Endoscopic management of gastric, duodenal and rectal NETs: Position paper from the Italian Association for Neuroendocrine Tumors (Itanet), Italian Society of Gastroenterology (SIGE), Italian Society of Digestive Endoscopy (SIED). Dig Liver Dis 2024;56(4):589–600.

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International, Multicenter Analysis of Endoscopic Full-Thickness Resection of Duodenal Neuroendocrine Tumors

Collaborators

Affiliations

International, Multicenter Analysis of Endoscopic Full-Thickness Resection of Duodenal Neuroendocrine Tumors

Authors

Collaborators

Affiliations

Abstract

References

Grants and funding

LinkOut - more resources

Full Text Sources