OUTCOMES OF ENDOSCOPIC RESECTION FOR FOREGUT NEUROENDOCRINE TUMORS, A SYSTEMATIC REVIEW AND META ANALYSIS
DDW ePoster Library. Ohman E. 05/02/26; 4197743; Su1221
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Abstract
Discussion Forum (0)
Introduction: Foregut neuroendocrine tumors (NET) are often small, well-differentiated lesions with low metastatic potential, making them suitable for endoscopic therapy. Endoscopic resection (ER) techniques for removing foregut NETs include endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and endoscopic full-thickness resection (EFTR). We aim to systematically evaluate the efficacy and safety of ER for foregut NETs.
Methods:
We conducted a comprehensive literature search of multiple electronic databases from inception through October 2025. Lesion baseline characteristics were collected. The primary outcomes were R0 resection , recurrence rate, and en-bloc resection. The secondary outcomes were adverse events and the need for surgical intervention. Pooled proportions were estimated using random-effects models. Heterogeneity was quantified with τ2 and I2 statistics. Egger’s test was used to evaluated small study effect.
Results:
Literature search yielded 6346 citations. 46 studies with 1765 patients and 1909 lesion were included. EMR was performed in 65.0% (N= 1201) of lesions, with ESD in 25.1% (N= 463) and EFTR in 9.9% (N= 182). The crude mean age was 58.9 years, and 53.5% were male. The mean lesion size was 8.1 mm, and location was the duodenum in 51.0%, stomach in 48.9%, and esophagus in 0.05%. The WHO tumor grade was G1 77.9%, G2 21.9%, G3 0.18%. Depth of invasion was intramucosal in 18.3 %, submucosal in 74.5 %, and muscularis propria in 7.4 %. Lymphovascular invasion was reported in 7.3 % of cases.
The pooled R0 resection rate was 73.7% (95% CI, 64.5–82.1; I2=82.9%; τ2=0.114; p=0.87) (Figure 1). The pooled local recurrence rate was 5.5% (95% CI, 1.9–10.3; I2=85.9%; τ2=0.1137; p=0.34) (Figure 2). The median follow up duration was 39.5 (5.6-95.7) The pooled en-bloc resection rate was 97.4% (95% CI, 95.3–99.0), with low-to-moderate heterogeneity (I2=26.8%; τ2=0.0109; P=0.35). The pooled post ER bleeding rate was 5.0% (95% CI, 2.2–8.4; I2=52.8%; τ2=0.0317; p=0.65) and the pooled perforation rate was 2.8% (95% CI, 0.9–5.3; I2=36.7%; τ2=0.0166; p=0.29). The need for additional surgery was reported in 13 studies; the pooled rate being 4.1% (95% CI,2.3–6.1; I2=0%; τ2=0; p=0.30). In random-effects meta-regression, mean lesion size, mean age, and study size were not significantly associated with en bloc resection, R0 resection, recurrence, bleeding, perforation, or need for additional surgery (all p=0.10).
Conclusion:
ER is an effective and safe treatment for foregut NETs, with acceptable en bloc and R0 resection rates, low recurrence, and low adverse event and surgical intervention rates, supporting its use as a primary therapeutic approach for appropriately selected lesions. Future studies should focus on comparative outcomes among different ER techniques stratified by location and lesion size.
Methods:
We conducted a comprehensive literature search of multiple electronic databases from inception through October 2025. Lesion baseline characteristics were collected. The primary outcomes were R0 resection , recurrence rate, and en-bloc resection. The secondary outcomes were adverse events and the need for surgical intervention. Pooled proportions were estimated using random-effects models. Heterogeneity was quantified with τ2 and I2 statistics. Egger’s test was used to evaluated small study effect.
Results:
Literature search yielded 6346 citations. 46 studies with 1765 patients and 1909 lesion were included. EMR was performed in 65.0% (N= 1201) of lesions, with ESD in 25.1% (N= 463) and EFTR in 9.9% (N= 182). The crude mean age was 58.9 years, and 53.5% were male. The mean lesion size was 8.1 mm, and location was the duodenum in 51.0%, stomach in 48.9%, and esophagus in 0.05%. The WHO tumor grade was G1 77.9%, G2 21.9%, G3 0.18%. Depth of invasion was intramucosal in 18.3 %, submucosal in 74.5 %, and muscularis propria in 7.4 %. Lymphovascular invasion was reported in 7.3 % of cases.
The pooled R0 resection rate was 73.7% (95% CI, 64.5–82.1; I2=82.9%; τ2=0.114; p=0.87) (Figure 1). The pooled local recurrence rate was 5.5% (95% CI, 1.9–10.3; I2=85.9%; τ2=0.1137; p=0.34) (Figure 2). The median follow up duration was 39.5 (5.6-95.7) The pooled en-bloc resection rate was 97.4% (95% CI, 95.3–99.0), with low-to-moderate heterogeneity (I2=26.8%; τ2=0.0109; P=0.35). The pooled post ER bleeding rate was 5.0% (95% CI, 2.2–8.4; I2=52.8%; τ2=0.0317; p=0.65) and the pooled perforation rate was 2.8% (95% CI, 0.9–5.3; I2=36.7%; τ2=0.0166; p=0.29). The need for additional surgery was reported in 13 studies; the pooled rate being 4.1% (95% CI,2.3–6.1; I2=0%; τ2=0; p=0.30). In random-effects meta-regression, mean lesion size, mean age, and study size were not significantly associated with en bloc resection, R0 resection, recurrence, bleeding, perforation, or need for additional surgery (all p=0.10).
Conclusion:
ER is an effective and safe treatment for foregut NETs, with acceptable en bloc and R0 resection rates, low recurrence, and low adverse event and surgical intervention rates, supporting its use as a primary therapeutic approach for appropriately selected lesions. Future studies should focus on comparative outcomes among different ER techniques stratified by location and lesion size.
Introduction: Foregut neuroendocrine tumors (NET) are often small, well-differentiated lesions with low metastatic potential, making them suitable for endoscopic therapy. Endoscopic resection (ER) techniques for removing foregut NETs include endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and endoscopic full-thickness resection (EFTR). We aim to systematically evaluate the efficacy and safety of ER for foregut NETs.
Methods:
We conducted a comprehensive literature search of multiple electronic databases from inception through October 2025. Lesion baseline characteristics were collected. The primary outcomes were R0 resection , recurrence rate, and en-bloc resection. The secondary outcomes were adverse events and the need for surgical intervention. Pooled proportions were estimated using random-effects models. Heterogeneity was quantified with τ2 and I2 statistics. Egger’s test was used to evaluated small study effect.
Results:
Literature search yielded 6346 citations. 46 studies with 1765 patients and 1909 lesion were included. EMR was performed in 65.0% (N= 1201) of lesions, with ESD in 25.1% (N= 463) and EFTR in 9.9% (N= 182). The crude mean age was 58.9 years, and 53.5% were male. The mean lesion size was 8.1 mm, and location was the duodenum in 51.0%, stomach in 48.9%, and esophagus in 0.05%. The WHO tumor grade was G1 77.9%, G2 21.9%, G3 0.18%. Depth of invasion was intramucosal in 18.3 %, submucosal in 74.5 %, and muscularis propria in 7.4 %. Lymphovascular invasion was reported in 7.3 % of cases.
The pooled R0 resection rate was 73.7% (95% CI, 64.5–82.1; I2=82.9%; τ2=0.114; p=0.87) (Figure 1). The pooled local recurrence rate was 5.5% (95% CI, 1.9–10.3; I2=85.9%; τ2=0.1137; p=0.34) (Figure 2). The median follow up duration was 39.5 (5.6-95.7) The pooled en-bloc resection rate was 97.4% (95% CI, 95.3–99.0), with low-to-moderate heterogeneity (I2=26.8%; τ2=0.0109; P=0.35). The pooled post ER bleeding rate was 5.0% (95% CI, 2.2–8.4; I2=52.8%; τ2=0.0317; p=0.65) and the pooled perforation rate was 2.8% (95% CI, 0.9–5.3; I2=36.7%; τ2=0.0166; p=0.29). The need for additional surgery was reported in 13 studies; the pooled rate being 4.1% (95% CI,2.3–6.1; I2=0%; τ2=0; p=0.30). In random-effects meta-regression, mean lesion size, mean age, and study size were not significantly associated with en bloc resection, R0 resection, recurrence, bleeding, perforation, or need for additional surgery (all p=0.10).
Conclusion:
ER is an effective and safe treatment for foregut NETs, with acceptable en bloc and R0 resection rates, low recurrence, and low adverse event and surgical intervention rates, supporting its use as a primary therapeutic approach for appropriately selected lesions. Future studies should focus on comparative outcomes among different ER techniques stratified by location and lesion size.
Methods:
We conducted a comprehensive literature search of multiple electronic databases from inception through October 2025. Lesion baseline characteristics were collected. The primary outcomes were R0 resection , recurrence rate, and en-bloc resection. The secondary outcomes were adverse events and the need for surgical intervention. Pooled proportions were estimated using random-effects models. Heterogeneity was quantified with τ2 and I2 statistics. Egger’s test was used to evaluated small study effect.
Results:
Literature search yielded 6346 citations. 46 studies with 1765 patients and 1909 lesion were included. EMR was performed in 65.0% (N= 1201) of lesions, with ESD in 25.1% (N= 463) and EFTR in 9.9% (N= 182). The crude mean age was 58.9 years, and 53.5% were male. The mean lesion size was 8.1 mm, and location was the duodenum in 51.0%, stomach in 48.9%, and esophagus in 0.05%. The WHO tumor grade was G1 77.9%, G2 21.9%, G3 0.18%. Depth of invasion was intramucosal in 18.3 %, submucosal in 74.5 %, and muscularis propria in 7.4 %. Lymphovascular invasion was reported in 7.3 % of cases.
The pooled R0 resection rate was 73.7% (95% CI, 64.5–82.1; I2=82.9%; τ2=0.114; p=0.87) (Figure 1). The pooled local recurrence rate was 5.5% (95% CI, 1.9–10.3; I2=85.9%; τ2=0.1137; p=0.34) (Figure 2). The median follow up duration was 39.5 (5.6-95.7) The pooled en-bloc resection rate was 97.4% (95% CI, 95.3–99.0), with low-to-moderate heterogeneity (I2=26.8%; τ2=0.0109; P=0.35). The pooled post ER bleeding rate was 5.0% (95% CI, 2.2–8.4; I2=52.8%; τ2=0.0317; p=0.65) and the pooled perforation rate was 2.8% (95% CI, 0.9–5.3; I2=36.7%; τ2=0.0166; p=0.29). The need for additional surgery was reported in 13 studies; the pooled rate being 4.1% (95% CI,2.3–6.1; I2=0%; τ2=0; p=0.30). In random-effects meta-regression, mean lesion size, mean age, and study size were not significantly associated with en bloc resection, R0 resection, recurrence, bleeding, perforation, or need for additional surgery (all p=0.10).
Conclusion:
ER is an effective and safe treatment for foregut NETs, with acceptable en bloc and R0 resection rates, low recurrence, and low adverse event and surgical intervention rates, supporting its use as a primary therapeutic approach for appropriately selected lesions. Future studies should focus on comparative outcomes among different ER techniques stratified by location and lesion size.
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