Neuroendocrine Tumors
Conditions
Brief summary
Introduction : The incidence of duodenal neuroendocrine tumors (DNETs) is increasing. Endoscopic resection is recommended for the management of small DNETs measuring ≤10 mm. Various endoscopic techniques have been utilized for the resection of DNETs including endoscopic mucosal resection (EMR), band ligation assisted EMR, endoscopic submucosal dissection (ESD). However, the published studies report a high rate of histologically incomplete resection even with ESD. More recently, device assisted endoscopic full thickness resection (EFTR) has emerged as a safe and effective resection modality in cases with upper and lower gastrointestinal (GI) mucosal as well as submucosal lesions. There is limited data on the outcomes of EFTR in cases with DNETs. In this study, we aim to compare the rate of histologically complete resection (R0) with ESD and EFTR in cases with DNETs.
Detailed description
Primary objective: Rate of R0 resection in both the groups Secondary outcomes: 1. Technical success: defined as en-bloc resection of the lesion without any residual lesion endoscopically 2. Procedure duration 3. Adverse Events Inclusion criteria: 1. Adult patients (≥18 years) with biopsy proven duodenal neuroendocrine tumors (DNETs) 2. Size of the lesion \<15 mm 3. Absence of local and distant metastases (EUS and DOTANOC scan) 4. Willing to provide informed consent Exclusion criteria: 1. Large lesions \>15 mm 2. Invasion of muscularis layer and beyond on imaging (EUS) 3. Scarring or deformity in duodenum 4. Active duodenal ulcer 5. History of prior resection 6. Coagulopathy
Interventions
PROCEDUREEndoscopic submucosal dissection
Endoscopic resection is recommended for the management of small DNETs measuring ≤10 mm. Various endoscopic techniques have been utilized for the resection of DNETs including endoscopic mucosal resection (EMR), band ligation assisted EMR, endoscopic submucosal dissection (ESD). However, the published studies report a high rate of histologically incomplete resection even with ESD. More recently, device assisted endoscopic full thickness resection (EFTR) has emerged as a safe and effective resection modality in cases with upper and lower gastrointestinal (GI) mucosal as well as submucosal lesions. There is limited data on the outcomes of EFTR in cases with DNETs.
DEVICEEFTR
Initially, the lesion will be marked circumferentially using the FTRD probe available with the device (Forced Coag, E1, 20W). Subsequently, wire guided balloon dilatation of the pyloric channel will be performed. The device will be mounted over a therapeutic channel gastroscope and negotiated across the cricopharynx over the guidewire with or without assistance of dilating balloon available with the device. After reaching the target site, the lesion will be pulled withing the FTRD cap with the help of grasping forceps and gentle suctioning. The clip will be fired after ensuring the entry of the lesion inside the cap, the premounted snare closed and electrocautery activated to cut the grasped tissue (HighCut 200W, Effect 4).
Sponsors
Asian Institute of Gastroenterology, India
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
1. Adult patients (≥18 years) with biopsy proven duodenal neuroendocrine tumors (DNETs) 2. Size of the lesion \<15 mm 3. Absence of local and distant metastases (EUS and DOTANOC scan) 4. Willing to provide informed consent
Exclusion criteria
1. Large lesions \>15 mm 2. Invasion of muscularis layer and beyond on imaging (EUS) 3. Scarring or deformity in duodenum 4. Active duodenal ulcer 5. History of prior resection 6. Coagulopathy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Rate of R0 resection in both the groups | 7 days | Endoscopically and pathologically complete resection |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Technical success: defined as en-bloc resection of the lesion without any residual lesion endoscopically | 7 days | Endoscopically complete resection |
| Procedure duration | 7 days | Time to complete each procedure in minutes |
| Adverse Events | 7 days | Adverse events during and after the procedure |
Countries
India
Contacts
Primary ContactZaheer Dr Nabi, MBBS MD DNB
Backup ContactAyush Dr Singh, MBBS MD
Outcome results
None listed