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Rossi RE, Masoni B, Massironi S, Marcozzi G, Franchellucci G, Zullo A, Facciorusso A, Carrara S, Mahmud N, Migliorisi G, Ferretti S, Maselli R, Hassan C, Repici A. Endoscopic Resection for Duodenal Neuroendocrine Neoplasms between 10 and 20 mm-A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:1466. [PMID: 38592317 PMCID: PMC10934162 DOI: 10.3390/jcm13051466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 04/10/2024] Open
Abstract
Background. The optimal management of duodenal neuroendocrine neoplasms (dNENs) sized 10-20 mm remains controversial and although endoscopic resection is increasingly performed instead of surgery, the therapeutic approach in this setting is not fully standardized. We performed a systematic review of the literature and a meta-analysis to clarify the outcomes of endoscopic resection for 10-20 mm dNENs in terms of efficacy (i.e., recurrence rate) and safety. Methods. A computerized literature search was performed using relevant keywords to identify pertinent articles published until January 2023. Results. Seven retrospective studies were included in this systematic review. The overall recurrence rate was 14.6% (95%CI 5.4-27.4) in 65 patients analyzed, without significant heterogeneity. When considering studies specifically focused on endoscopic mucosal resection, the recurrence rate was 20.5% (95%CI 10.7-32.4), without significant heterogeneity. The ability to obtain the free margin after endoscopic resection ranged between 36% and 100%. No complications were observed in the four studies reporting this information. Conclusions. Endoscopic resection could be the first treatment option in patients with dNENs sized 10-20 mm and without evidence of metastatic disease. Further studies are needed to draw more solid conclusions, particularly in terms of superiority among the available endoscopic techniques.
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Affiliation(s)
- Roberta Elisa Rossi
- Gastroenterology and Endoscopy Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (B.M.); (G.M.); (G.F.); (S.C.); (G.M.); (S.F.); (R.M.); (C.H.); (A.R.)
| | - Benedetta Masoni
- Gastroenterology and Endoscopy Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (B.M.); (G.M.); (G.F.); (S.C.); (G.M.); (S.F.); (R.M.); (C.H.); (A.R.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
| | - Sara Massironi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Fondazione IRCCS San Gerardo dei Tintori, Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy;
| | - Giacomo Marcozzi
- Gastroenterology and Endoscopy Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (B.M.); (G.M.); (G.F.); (S.C.); (G.M.); (S.F.); (R.M.); (C.H.); (A.R.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
| | - Gianluca Franchellucci
- Gastroenterology and Endoscopy Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (B.M.); (G.M.); (G.F.); (S.C.); (G.M.); (S.F.); (R.M.); (C.H.); (A.R.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
| | - Angelo Zullo
- Gastroenterology Unit, ‘Nuovo Regina Margherita’ Hospital, 00153 Rome, Italy;
| | - Antonio Facciorusso
- Section of Gastroenterology, Department of Medical Sciences, University of Foggia, 71122 Foggia, Italy;
| | - Silvia Carrara
- Gastroenterology and Endoscopy Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (B.M.); (G.M.); (G.F.); (S.C.); (G.M.); (S.F.); (R.M.); (C.H.); (A.R.)
| | - Nadim Mahmud
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA;
| | - Giulia Migliorisi
- Gastroenterology and Endoscopy Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (B.M.); (G.M.); (G.F.); (S.C.); (G.M.); (S.F.); (R.M.); (C.H.); (A.R.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
| | - Silvia Ferretti
- Gastroenterology and Endoscopy Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (B.M.); (G.M.); (G.F.); (S.C.); (G.M.); (S.F.); (R.M.); (C.H.); (A.R.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
| | - Roberta Maselli
- Gastroenterology and Endoscopy Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (B.M.); (G.M.); (G.F.); (S.C.); (G.M.); (S.F.); (R.M.); (C.H.); (A.R.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
| | - Cesare Hassan
- Gastroenterology and Endoscopy Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (B.M.); (G.M.); (G.F.); (S.C.); (G.M.); (S.F.); (R.M.); (C.H.); (A.R.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
| | - Alessandro Repici
- Gastroenterology and Endoscopy Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (B.M.); (G.M.); (G.F.); (S.C.); (G.M.); (S.F.); (R.M.); (C.H.); (A.R.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
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Massironi S, Rossi RE, Milanetto AC, Andreasi V, Campana D, Nappo G, Partelli S, Gallo C, Scaravaglio M, Zerbi A, Panzuto F, Pasquali C, Falconi M, Invernizzi P. Duodenal Gastric Metaplasia and Duodenal Neuroendocrine Neoplasms: More Than a Simple Coincidence? J Clin Med 2022; 11:jcm11092658. [PMID: 35566783 PMCID: PMC9099754 DOI: 10.3390/jcm11092658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/16/2022] [Accepted: 05/06/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Duodenal gastric metaplasia (DGM) is considered a precancerous lesion. No data are available regarding its possible role as a risk factor for duodenal neuroendocrine neoplasms (dNENs). Aims: To assess the prevalence of DGM in a cohort of dNENs. Methods: Subgroup analysis of a retrospective study including dNEN patients who underwent surgical resection between 2000 and 2019 and were observed at eight Italian tertiary referral centers. Results: 109 dNEN patients were evaluated. Signs of DGM associated with the presence of dNEN were reported in 14 patients (12.8%). Among these patients, nine (64.4%) had a dNEN of the superior part of the duodenum, one (7.1%) a periampullary lesion, three (21.4%) a dNEN located in the second portion of the duodenum, with a different localization distribution compared to patients without DGM (p = 0.0332). Ten were G1, three G2, and in one patient the Ki67 was not available. In the group with DGM, six patients (35.7%) were classified at stage I, five (28.6%) at stage II, three (21.4%) at stage III, and no one at stage IV. In the group without DGM, 20 patients (31%) were at stage I, 15 (15%) at stage II, 42 (44%) at stage III, and 19 (20%) at stage IV (p = 0.0236). At the end of the study, three patients died because of disease progression. Conclusions: our findings might suggest that DGM could represent a feature associated with the occurrence of dNEN, especially for forms of the superior part of the duodenum, which should be kept in mind in the endoscopic follow up of patients with DGM. Interestingly, dNEN inside DGM showed a more favorable staging, with no patients in stage IV. The actual relationship and the clinical relevance of this possible association require further clarification.
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Affiliation(s)
- Sara Massironi
- Division of Gastroenterology, San Gerardo Hospital, University of Milano-Bicocca School of Medicine, 20900 Monza, Italy; (C.G.); (M.S.); (P.I.)
- Correspondence: (S.M.); (R.E.R.)
| | - Roberta Elisa Rossi
- HBP Surgery, Hepatology and Liver Transplantation Unit, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale Tumori (INT, National Cancer Institute), 20133 Milan, Italy
- Correspondence: (S.M.); (R.E.R.)
| | - Anna Caterina Milanetto
- Pancreatic and Endocrine Digestive Surgical Unit, Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, 35122 Padua, Italy; (A.C.M.); (C.P.)
| | - Valentina Andreasi
- Pancreatic Surgery Unit, ENETS Center of Excellence, San Raffaele IRCCS, “Vita-Salute” University, 20132 Milan, Italy; (V.A.); (S.P.); (M.F.)
| | - Davide Campana
- ENETS Center of Excellence, Department of Experimental, Diagnostic and Specialty Medicine, Bologna University, St. Orsola-Malpighi University Hospital, 40138 Bologna, Italy;
| | - Gennaro Nappo
- ENETS Center of Excellence, Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Italy; (G.N.); (A.Z.)
| | - Stefano Partelli
- Pancreatic Surgery Unit, ENETS Center of Excellence, San Raffaele IRCCS, “Vita-Salute” University, 20132 Milan, Italy; (V.A.); (S.P.); (M.F.)
| | - Camilla Gallo
- Division of Gastroenterology, San Gerardo Hospital, University of Milano-Bicocca School of Medicine, 20900 Monza, Italy; (C.G.); (M.S.); (P.I.)
| | - Miki Scaravaglio
- Division of Gastroenterology, San Gerardo Hospital, University of Milano-Bicocca School of Medicine, 20900 Monza, Italy; (C.G.); (M.S.); (P.I.)
| | - Alessandro Zerbi
- ENETS Center of Excellence, Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Italy; (G.N.); (A.Z.)
| | - Francesco Panzuto
- Digestive Disease Unit, ENETS Center of Excellence, Sant’Andrea University Hospital, 00189 Rome, Italy;
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy
| | - Claudio Pasquali
- Pancreatic and Endocrine Digestive Surgical Unit, Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, 35122 Padua, Italy; (A.C.M.); (C.P.)
| | - Massimo Falconi
- Pancreatic Surgery Unit, ENETS Center of Excellence, San Raffaele IRCCS, “Vita-Salute” University, 20132 Milan, Italy; (V.A.); (S.P.); (M.F.)
| | - Pietro Invernizzi
- Division of Gastroenterology, San Gerardo Hospital, University of Milano-Bicocca School of Medicine, 20900 Monza, Italy; (C.G.); (M.S.); (P.I.)
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