Year 2004 / Volume 96 / Number 12
Original
Endoscopic ultrasound-assisted endoscopic resection of carcinoid tumors of the gastrointestinal tract

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D. Martínez-Ares, J. Souto-Ruzo, M. J. Varas Lorenzo, J. C. Espinós Pérez, J. Yáñez López, R. Abad Belando, P. A. Alonso Aguirre, J. M. Miquel Colell and J. L. Vázquez Iglesias

Abstract
Introduction: usually found in the gastrointestinal tract, carcinoids are the most frequent neuroendocrine tumors. Most of these lesions are located in areas that are difficult to access using
conventional endoscopy (small intestine and appendix); carcinoid tumors found in the gastroduodenal tract and in the large intestine
can be studied endoscopically; in these cases, if localized disease is confirmed, local treatment by endoscopic resection may be the treatment of choice. Since endoscopic ultrasonography has been
shown to be the technique of choice for the study of tumors exhibiting submucosal growth, the selection of patients who are candidates
for a safe and effective local resection should be based on this technique.

Patients and method: we selected patients with gastrointestinal carcinoid tumors who were endoscopically treated between 1997 and 2002. Those patients with tumors measuring
less than 10 mm, which had not penetrated the muscularis propria, and those with localized disease were considered candidates for endoscopic resection. The endpoints of this study were to assess the effectiveness (complete resection) and safety (complications) of the technique. Follow-up consisted of eschar biopsies performed one month and t welve months after the resection.

Results: during the aforementioned period, we resected endoscopically 24 tumors in 21 patients (mean age: 51.7 years; 71.5% males). Most lesions were incidental discoveries made during
examinations indicated for other reasons. Resection was indicated in most cases as a result of the suspected presence of a carcinoid tumor after endoscopic ultrasonography. Endoscopic
ultrasonography also enabled us to clearly identify the layer where the lesion had originated, as well as the size of the lesion. The carcinoid tumor was removed in 13 cases (54.2%) by using the conventional snare polypectomy technique, in 9 cases (37.5%) assisted by a submucosal injection of saline solution and/or adrenaline, and in 2 cases (8.3%) after ligating the lesion with elastic bands. In
all cases the resection was complete, with no recurrence during the follow-up period, and no major complications, except for a single case in which a post-polypectomy hemorrhage occurred
that was endoscopically solved.

Conclusions: in properly selected patients, the endoscopic resection of carcinoid tumors is a safe and effective technique that permits a complete resection in all cases with few complications.
Endoscopic ultrasonography is the technique of choice for selecting the patients who are candidates for endoscopic resection.
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D. Martínez-Ares, J. Souto-Ruzo, M. J. Varas Lorenzo, J. C. Espinós Pérez, J. Yáñez López, R. Abad Belando, P. A. Alonso Aguirre, J. M. Miquel Colell and J. L. Vázquez Iglesias. Endoscopic ultrasound-assisted endoscopic resection of carcinoid tumors of the gastrointestinal tract. 0


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