Background: Although small bowel (SB) neuroendocrine tumours (SBNETs) often present as indolent lesions, late diagnosis may result in poor outcomes. Successful management is therefore dependent on early identification. Double-balloon enteroscopy (DBE) enables direct SB mucosal visualisation, sampling and endotherapy. Our aim was to evaluate the role of DBE for early diagnosis and management of SBNETs.
Methods: Retrospective review of all SBNETs diagnosed/evaluated by DBE at our institution (November 2016July 2017). Demographic, endoscopic, histopathological and follow-up data were collated/analyzed.
Results: A total of five patients were included (mean age: 49 (S.D.±13.2) years; male/female ratio: 1.5). All patients presented with obscure-overt mid-gut bleeding (OOGIB) (n=3) or iron deficiency anaemia (n=2). A total of six SBNETs were identified in the five patients at DBE. Dedicated SB radiological imaging was performed in four patients and this showed a potential primary lesion in three cases. At DBE, identified lesions were marked with a submucosal tattoo of sterile India ink and histopathology of lesion biopsies was diagnostic of SBNETs in all five patients. Three patients underwent minimally-invasive oncological SB resection (mean resection length: 30.3 (S.D.±15.1) cm); marking tattoos placed at DBE, successfully guided surgery in all three cases; the remaining two patients await resection. The final number of SBNETs identified at surgery was 6 (average dimension: 7.9 (S.D.±3.8) mm; mean number/patient: 2 (S.D.±0.8)). Histopathological evaluation: Well-differentiated grade 1 SBNET (n=4; 66.6%), well-differentiated grade 2 SBNET (n=2; 33.3%). The largest tumour (diameter: 15 mm), a well differentiated grade 2 NET was not identified by Gallium-68 PETCT scanning during staging/assessment.
Conclusion: DBE is an essential procedure for early diagnosis and pre-surgical assessment of SBNETs. The role of DBE also extends to localization and marking which may be used to guide minimally-invasive surgical resection.
04 Dec 2017
UK and Ireland Neuroendocrine Tumour Society