Seguimento de longo prazo de pacientes com tumor neuroendócrino da papila duodenal submetidos à papilectomia endoscópica: série de casos e revisão da literatura

GALETTI, Facundo; ARAÚJO-FILHO, Jessé Clementino de; ANDRADE, Eliza Ribeiro Alves de; TAGLIERI, Eloy; MICELLI-NETO, Otávio; ARDENGH, José Celso

doi:10.1590/S0004-2803.202100000-33

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REVIEW • Arq. Gastroenterol. 58 (02) • Apr-Jun 2021 • https://doi.org/10.1590/S0004-2803.202100000-33 copiar

Seguimento de longo prazo de pacientes com tumor neuroendócrino da papila duodenal submetidos à papilectomia endoscópica: série de casos e revisão da literatura

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

CONTEXTO:

Tumores neuroendócrinos da papila duodenal (TNE-PD) são raros. A cirurgia deve ser recomendada para o tratamento. No entanto, apresentam altas taxas de morbimortalidade. A papilectomia endoscópica (PE) é segura e eficaz para a ressecção completa de tumores nesta região.

OBJETIVO:

Descrever uma série de casos de TNEs-PD ressecados por PE e realizar uma revisão da literatura.

MÉTODOS:

Pacientes com TNEs-PD submetidos a PE como tratamento primário com intenção curativa entre jan/2008 e mar/2020 em um centro de referência terciário foram estudados. Uma pesquisa abrangente foi feita no MEDLINE. A estratégia de busca foi desenhada para encontrar todos os artigos relacionados a TNEs-PD publicados na literatura, que haviam sido submetidos a PE.

RESULTADOS:

Seis pacientes foram submetidos a PE por apresentar TNEs-PD, sendo quatro mulheres, com média de idade de 66 anos (22-96). O diâmetro médio dos TNEs-PD foi de 1,8±0,4 cm. Quatro dos seis pacientes foram acompanhados, um dos quais sofreu recidiva no local da ressecção após 3 meses e foi encaminhado para cirurgia (pT3n1b), e os três pacientes restantes não apresentaram recorrência endoscópica ou histológica durante os períodos de acompanhamento de 10, 7 e 4 anos, respectivamente. Dezoito artigos foram encontrados no MEDLINE. Os artigos incluíram relatos de casos de TNEs-PD tratados pela PE.

CONCLUSÃO:

A PE é segura e eficaz para TNEs-PD ≤20 mm, confinados à camada submucosa, bem diferenciados e sem metástases locais ou remotas. Acompanhamento endoscópico adequado e tratamento cirúrgico definitivo na vigência de recidiva são necessários.

Palavras-chave:
Tumor neuroendócrino; papilectomia endoscópica; ultrassonografia endoscópica; papila duodenal; ampola de Vater; tratamento endoscópico; diagnóstico

Characteristics	n
Sex, n (%)	Female, 4 (66)
Age (median), years (range)	66 (22-96)
Presenting symptoms, n=6 patients
Nonspecific abdominal pain	3
Jaundice	2
Pancreatitis	1
Clinical laboratory, median (SD)
Total billirubin (mg/dL)	1.22±0.5
Amilase (mg/dL)	284.3±38
Endoscopic ultrasound staging, n=7 tumors*
T1 N0	7
Mean diameter common bile duct, median, mm (SD)	5.5±2.6
Mean diameter main pancreatic duct, median, mm (SD)	3.8±2.2
Initial biopsies, n=7 tumors*
Neuroendocrine tumor	6
Villous adenoma	1

Variables	n (%)
Type of resection, n=7 tumors*
En bloc	6 (86)
Piecemeal	1 (14)
Tumor size, mm (SD)	1.8±0.4
Final pathologic finding, n=7 tumors*
Neuroendocrine tumor	4 (58)
Somatostatinoma	2 (28)
Neuroendocrine carcinoma	1 (14)
Endoscopic success, n=6 patients	5 (83.3)
Adverse events post endoscopic papillectomy, n=6 patients	4 (66.6)
Early bleeding	2 (76.8)
Delayed bleeding	1 (16.6)
Perforation (duodenal papillary disinsertion)	1 (16.6)
Referral to surgery after failed papillectomy, n=2/6 patients
Early therapeutic failure	1 (50)
Perforation (duodenal papillary disinsertion)	1 (50)
Follow-Up
Follow-up, n=4/6 patients, months median (SD)	62.6±33.7
Recurrence during follow-up, n=4/6 patients	1 (25)

Author	Year	N	Age, y/median	Sex (F-M)	Size (mm)	Symptoms	Preoperative biopsy
							DP-NET	Adenoma
Pyun DK et al.³3. Pyun DK, Moon G, Han J, Kim MH, Lee SS, Seo DW, et al. A carcinoid tumor of the ampulla of Vater treated by endoscopic snare papillectomy. Korean J Intern Med. 2004;19:257-60.	2004	1	62	M	7	NR	(+)	(-)
Niido T et al.¹⁹19. Niido T, Itoi T, Harada Y, Haruyama K, Ebihara Y, Tsuchida A, et al. Carcinoid of major duodenal papilla. Gastrointest Endosc . 2005;61:106-7.	2005	1	51	NR	24	NR	NR	NR
Chahal P et al.¹²12. Chahal P, Prasad GA, Sanderson SO, Gostout CJ, Levy MJ, Baron TH. Endoscopic resection of nonadenomatous ampullary neoplasms. J Clin Gastroenterol. 2007;41:661-6.	2007	1	57	F	15	GERD	(+)	(-)
Gilani N et al.⁵5. Gilani N, Ramirez FC. Endoscopic resection of an ampullary carcinoid presenting with upper gastrointestinal bleeding: a case report and review of the literature. World J Gastroenterol. 2007;13:1268-70.	2007	1	71	M	15	NR	NR	NR
Fukatsu H et al.⁴4. Fukatsu H, Kawamoto H, Fujii M, Tsutsumi K, Kato H, Hirao K, et al. Periampullary carcinoid tumor. Endoscopy. 2007;39 Suppl 1:E49-50.	2007	1	71	M	15	NR	(+)	(-)
Katsinelos P et al.¹⁷17. Katsinelos P, Kountouras J, Zavos C, Chatzimavroudis G, Paroutoglou G. Recurrent acute pancreatitis caused by intra-ampullary carcinoid tumor. Gastrointest Endosc . 2009;69:1387-8; discussion 8.	2009	1	59	F	NR	ABP	NR	NR
YI H et al.⁷7. Yi H, Wu C, Mou Y, Liu W, Li J, Zhang Q, et al. Successful en bloc resection of papillary neuroendocrine tumors by duodenoscope using endoscopic submucosal dissection method. Clin Res Hepatol Gastroenterol. 2012;36:e100-3.	2012	1	67	F	25	ABP	NR	NR
Odabasi M et al.⁶6. Odabasi M, Yildiz KM, Cengiz E, Hasan AH, Gunay E, Ozkan E, et al. Treatment of ampullary neuroendocrine tumor by endoscopic snare papillectomy. Am J Case Rep. 2013;14:439-43.	2013	1	45	F	20	ABP	(+)	(-)
Dhir V et al.¹³13. Dhir V, Joshi N, Vivekanandarajah S, Bhandari S, Bapat M, Maydeo A. Recurrent acute pancreatitis in a patient with wirsungocele and neuroendocrine tumor of ampulla of Vater. JOP. 2013;14:99-101.	2013	1	63	M	NR	AP	(+)	(-)
Lee SH et al.¹⁸18. Lee SH, Lee TH, Jang SH, Choi CY, Lee WM, Min JH, et al. Ampullary neuroendocrine tumor diagnosed by endoscopic papillectomy in previously confirmed ampullary adenoma. World J Gastroenterol . 2016;22:3687-92.	2016	1	53	F	10	DP	(-)	(+)
Attila T et al.¹¹11. Attila T, Parlak E, Alper E, Disibeyaz S, Cicek B, Odemis B. Endoscopic papillectomy of benign ampullary lesions: Outcomes from a multicenter study. Turk J Gastroenterol. 2018;29:325-34.	2017	1	NR	NR	NR	NR	NR	NR
Fukasawa A et al.¹⁵15. Fukasawa H, Tounou S, Nabetani M, Michida T. Endoscopic Resection of Ampullary Neuroendocrine Tumor. Intern Med. 2017;56:499-503.	2017	1	57	M	10	ASY	(+)	(-)
Seo YK et al.¹1. Seo YK, Choi JS. Endoscopic Papillectomy for Synchronous Major and Minor Duodenal Papilla Neuroendocrine Tumors. Korean J Gastroenterol. 2018;72:217-21.	2018	1	42	F	16	ABP	(+)	(-)
Dogeas E et al.¹⁴14. Dogeas E, Cameron JL, Wolfgang CL, Hirose K, Hruban RH, Makary MA, et al. Duodenal and Ampullary Carcinoid Tumors: Size Predicts Necessity for Lymphadenectomy. J Gastrointest Surg. 2017;21:1262-9.	2017	2	NR	NR	<10	NR	NR	NR
Will U et al.²¹21. Will U, Muller AK, Fueldner F, Wanzar I, Meyer F. Endoscopic papillectomy: data of a prospective observational study. World J Gastroenterol . 2013;19:4316-24.	2013	4	NR	NR	NR	NR	NR	NR
Vanoli A et al.²⁰20. Vanoli A, La Rosa S, Klersy C, Grillo F, Albarello L, Inzani F, et al. Four Neuroendocrine Tumor Types and Neuroendocrine Carcinoma of the Duodenum: Analysis of 203 Cases. Neuroendocrinology. 2017;104:112-25.	2017	4	NR	NR	11	NR	NR	NR
Gincul R et al.¹⁶16. Gincul R, Ponchon T, Napoleon B, Scoazec JY, Guillaud O, Saurin JC, et al. Endoscopic treatment of sporadic small duodenal and ampullary neuroendocrine tumors. Endoscopy. 2016;48:979-86.	2016	7	NR	NR	NR	NR	(+)	(-)
Galetti F et al.	2020	6*	63 (me)	(4-2)	16	ABP/J/AP	6 (+)	1 (+)

Author	Resection type	Procedure	Adverse events	Layer	Margins	Immunohistochemical (+)	Ki 67 Index	Mitosis	Grading criteria (ENETS/WHO)	Follow-up, months
Pyun DK et al.³3. Pyun DK, Moon G, Han J, Kim MH, Lee SS, Seo DW, et al. A carcinoid tumor of the ampulla of Vater treated by endoscopic snare papillectomy. Korean J Intern Med. 2004;19:257-60.	EP	SSI/PPS	N	M	(-)	CA / SY	NR	NR	NR	(-), 6
Niido T et al.¹⁹19. Niido T, Itoi T, Harada Y, Haruyama K, Ebihara Y, Tsuchida A, et al. Carcinoid of major duodenal papilla. Gastrointest Endosc . 2005;61:106-7.	EP	NR	NR	SB	(-)	CA / NSE / SE / SY	NR	NR	NR	(-), 18
Chahal P et al.¹²12. Chahal P, Prasad GA, Sanderson SO, Gostout CJ, Levy MJ, Baron TH. Endoscopic resection of nonadenomatous ampullary neoplasms. J Clin Gastroenterol. 2007;41:661-6.	EP	Non SSI	N	SB	(-)	CA / SY	NR	NR	NR	(-), 14
Gilani N et al.⁵5. Gilani N, Ramirez FC. Endoscopic resection of an ampullary carcinoid presenting with upper gastrointestinal bleeding: a case report and review of the literature. World J Gastroenterol. 2007;13:1268-70.	EP	Non SSI - PI - PPS	BL (EH)	MP	NR	CA / SE / SY	NR	NR	NR	(-) (time NR)
Fukatsu H et al.⁴4. Fukatsu H, Kawamoto H, Fujii M, Tsutsumi K, Kato H, Hirao K, et al. Periampullary carcinoid tumor. Endoscopy. 2007;39 Suppl 1:E49-50.	EP	Non SSI	N	M	NR	SO	NR	(-)	G1	NR
Katsinelos P et al.¹⁷17. Katsinelos P, Kountouras J, Zavos C, Chatzimavroudis G, Paroutoglou G. Recurrent acute pancreatitis caused by intra-ampullary carcinoid tumor. Gastrointest Endosc . 2009;69:1387-8; discussion 8.	EP	Non SSI	BL (EH)	NR	NR	NR	NR	NR	NR	(-), 4
Yi H et al.⁷7. Yi H, Wu C, Mou Y, Liu W, Li J, Zhang Q, et al. Successful en bloc resection of papillary neuroendocrine tumors by duodenoscope using endoscopic submucosal dissection method. Clin Res Hepatol Gastroenterol. 2012;36:e100-3.	ESD	NR	NR	SB	NR	NR	NR	NR	G2	(-), 6
Odabasi M et al.⁶6. Odabasi M, Yildiz KM, Cengiz E, Hasan AH, Gunay E, Ozkan E, et al. Treatment of ampullary neuroendocrine tumor by endoscopic snare papillectomy. Am J Case Rep. 2013;14:439-43.	EP	Non SSI/PPS	N	MP	(-)	CA / SY	<1%	(-)	G1	(-), 14
Dhir V et al.¹³13. Dhir V, Joshi N, Vivekanandarajah S, Bhandari S, Bapat M, Maydeo A. Recurrent acute pancreatitis in a patient with wirsungocele and neuroendocrine tumor of ampulla of Vater. JOP. 2013;14:99-101.	EP	Non SSI	N	NR	NR	CA / SY	<2%	NR	G1	NR
Lee SH et al.¹⁸18. Lee SH, Lee TH, Jang SH, Choi CY, Lee WM, Min JH, et al. Ampullary neuroendocrine tumor diagnosed by endoscopic papillectomy in previously confirmed ampullary adenoma. World J Gastroenterol . 2016;22:3687-92.	EP (Two-step)	SSI/PPS/(failed)	N	SB	(-)	SY	NR	NR	G1	(-), 24
Attila T et al. ¹¹11. Attila T, Parlak E, Alper E, Disibeyaz S, Cicek B, Odemis B. Endoscopic papillectomy of benign ampullary lesions: Outcomes from a multicenter study. Turk J Gastroenterol. 2018;29:325-34.	NR	NR	N	NR	(-)	NR	NR	NR	NR	(-), 24 (ME)
Fukasawa A et al.¹⁵15. Fukasawa H, Tounou S, Nabetani M, Michida T. Endoscopic Resection of Ampullary Neuroendocrine Tumor. Intern Med. 2017;56:499-503.	NR	PPS	BL (EH) / MP	SB	(-)	CA / SY	<2%	NR	G1	NR
Seo YK et al.¹1. Seo YK, Choi JS. Endoscopic Papillectomy for Synchronous Major and Minor Duodenal Papilla Neuroendocrine Tumors. Korean J Gastroenterol. 2018;72:217-21.	NR	NR	N	SB	(-)	SY	<2%	1 per 10 HPF	NR	(-), 16
Dogeas E et al.¹⁴14. Dogeas E, Cameron JL, Wolfgang CL, Hirose K, Hruban RH, Makary MA, et al. Duodenal and Ampullary Carcinoid Tumors: Size Predicts Necessity for Lymphadenectomy. J Gastrointest Surg. 2017;21:1262-9.	NR	NR	N	NR	NR	NR	NR	NR	NR	(-), 13 (ME)
Will U et al.²¹21. Will U, Muller AK, Fueldner F, Wanzar I, Meyer F. Endoscopic papillectomy: data of a prospective observational study. World J Gastroenterol . 2013;19:4316-24.	NR	NR	N	NR	NR	NR	NR	NR	NR	NR
Vanoli A et al.²⁰20. Vanoli A, La Rosa S, Klersy C, Grillo F, Albarello L, Inzani F, et al. Four Neuroendocrine Tumor Types and Neuroendocrine Carcinoma of the Duodenum: Analysis of 203 Cases. Neuroendocrinology. 2017;104:112-25.	NR	NR	N	NR	NR	NR	NR	NR	NR	1/4 (+), 114 (ME)
Gincul R et al.¹⁶16. Gincul R, Ponchon T, Napoleon B, Scoazec JY, Guillaud O, Saurin JC, et al. Endoscopic treatment of sporadic small duodenal and ampullary neuroendocrine tumors. Endoscopy. 2016;48:979-86.	EP	SSI / PPS	N	NR	5/7 (-) - 2/7 (+)	NR	NR	NR	6/7 G1 / 1/7 G2	1/7 (+), (G2)
Galetti F et al.	EP	Non SSI	3/4 BL / 1/4 PD (ST)	M (7)*	6/7* (-) - 1/7* (+)	CA / SY	6/7* <1% 1/7* >5%	NR	6/7* G1 / 1/7* G2	4/6 (-), 62.2 (ME)

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[1] Corresponding author: José Celso Ardengh. E-mail: jcelso@uol.com.br