EFFICACY OF ANTRECTOMY FOR PATIENTS WITH MULTIPLE TYPE I GASTRIC NEUROENDOCRINE TUMORS

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Introduction

Type I gastric neuroendocrine tumors (T1-GNETs) are caused by auto-immune gastritis and often occur in multiple lesions. Although endoscopic resection, such as endoscopic submucosal dissection (ESD), is often used for treatment of a small number of T1-GNET, antrectomy is also performed for multiple lesions. However, to date, the efficacy of antrectomy remains unclear.

Aims & Methods

Type I gastric neuroendocrine tumors (T1-GNETs) are caused by auto-immune gastritis and often occur in multiple lesions. Although endoscopic resection, such as endoscopic submucosal dissection (ESD), is often used for treatment of a small number of T1-GNET, antrectomy is also performed for multiple lesions. However, to date, the efficacy of antrectomy remains unclear.

Results

The median age of all patients was 54 years (range, 44–67 years). The ratio of male to female patients was 2:5. The number of tumors preoperatively observed in endoscopy was <10 in two patients, 10–20 in one, and >20 in four. The median size of largest tumor was 6 mm (range, 4–8 mm). Antrectomy was performed in three patients as initial treatment and in four as additional treatment after ESD. The number of tumors pathologically evaluated in resected specimens was <10 in four patients, 10–20 in two, and >20 in one. All tumors were limited to the submucosa. The median diameter of the largest tumor was 5 mm (range, 1.5–8 mm). The median gastrin levels significantly decreased from 3900 pg/mL (range, 2400–8000 pg/mL) to 73 pg/mL (range, 26–120 pg/mL) after antrectomy. Regarding postoperative assessment, tumor regression was observed in one patient and disappearance was observed in six at the follow-up endoscopy. The median period between antrectomy and tumor disappearance was 20 months (range, 5–49 months). No recurrence or cause-specific death occurred in all patients, with a median follow-up period of 48 months (range, 24–60 months).

	N=7
Age, median (range), years	54 (44-67)
Number of tumor (preoperative), n (%) < 10 10-20 > 20	2 (28.6) 1 (14.3) 4 (57.1)
Size of largest tumor (preoperative), median (range), mm	6 (4-8)
Number of tumor (resected specimen), n (%) < 10 10-20 > 20	4 (57.1) 2 (28.6) 1 (14.3)
Size of largest tumor (resected specimen), median (range), mm	5 (1.5-8)
Serum gastrin levels, median (range), pg/ml Pre Antrectomy Post Antrectomy	3900 (2400-8000) 73 (26-120)
Post Antrectomy status of residual tumors, n (%) Stable Progression Regression Disappearance	0 (0.0) 0 (0.0) 1 (14.3) 6 (85.7)
Period between Antrectomy and tumor disappearance, median (range), months After Antrectomy	20 (5-49)
Follow-up period after Antrectomy, median (range), month	Follow-up period after Antrectomy, median (range), month

Conclusion

Based on our findings, antrectomy does not only control local disease but also may lead to prevention of recurrence and regression of tumor persistence. Antrectomy was an effective treatment that could avoid total gastrectomy in patients with multiple T1-GNETs.

References

NCCN Clinical Practice Guidelines in Oncology: Neuroendocrine Tumors Version 2.2016

EFFICACY OF ANTRECTOMY FOR PATIENTS WITH MULTIPLE TYPE I GASTRIC NEUROENDOCRINE TUMORS

Yuki Morita 1, Ken Namikawa 1, Yohei Ikenoyama 1, Yoshitaka Tokai 1, Shoichi Yoshimizu 1, Yusuke Horiuchi 1, Akiyoshi Ishiyama 1, Toshiyuki Yoshio 1, Toshiaki Hirasawa 1, Kaoru Nakano 2, Souya Nunobe 1, Junko Fujisaki 1

1 Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

2 Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan|||Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan

Conference

UEG Week Copenhagen 2023

Topics

Oesophagus

Submission format

Abstract

Session

PP 01 Oesophageal, gastric and duodenal disorders (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

UEG Presentation

COMPUTER AIDED QUALITY CONTROL SYSTEM IMPROVES BARRETT’S NEOPLASIA DETECTION IN AN EX-VIVO SETTING

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Introduction

Early detection of neoplasia in Barrett’s Esophagus (BE) remains challenging. Although computer-aided detection (CADe) systems are increasingly available to support endoscopists, successful CADe implementation largely depends on the quality of endoscopic images, which can vary significantly in clinical practice. This study introduces an innovative computer-aided quality (CAQ) system designed for BE endoscopy, capable of assessing various image quality parameters, providing real-time feedback to the endoscopist, and operating in conjunction with an established CADe system.

Aims & Methods

The CAQ system was trained on 4,926 images from 243 BE patients to assess both objective (e.g., blurriness, illumination, and specular reflections) and subjective (i.e., mucosal cleanliness and esophageal expansion) image quality factors. The system is able to provide real-time feedback on these quality parameters to the endoscopist. Additionally, it is configured to function as a preprocessing filter for a previously developed CADe system, automatically excluding lower-quality images. To validate the CAQ system’s performance as a standalone tool, we constructed an endoscopic image quality test set, which included 647 images from 51 non-dysplastic BE patients across eight hospitals. These images were annotated for objective (e.g. motion blur, lighting) and subjective (i.e. esophageal expansion, mucosal cleanliness) image quality parameters by two experts. Additionally, to evaluate the CAQ system’s role as a preprocessing step for an established CADe system, we created the Barrett CADe test set, containing 956 frames from 62 neoplastic BE patients and 557 frames from 35 non-dysplastic BE patients from 12 Barrett referral centers. Outcome measures included agreement scores with experts for standalone image quality assessment and sensitivity, specificity, and Area-under-the-Curve (AUC) for BE neoplasia detection.

Results

As a stand-alone system, the CAQ system achieved Cohen’s Kappa scores for agreement with expert annotators of 0.73, 0.91, and 0.89 for objective image quality parameters, mucosal cleanliness, and esophageal expansion, respectively—comparable to inter-annotator scores of 0.73, 0.93, and 0.83. When used as a preprocessing filter for the CADe system, the CAQ system improved the CADe's sensitivity from 82% to 90% and the AUC from 87% to 91%, while specificity remained stable at 75% (Table 1).

Table 1. Performance of the CADe system for Barrett’s neoplasia detection with and without the CAQ system.

Evaluated by	Sensitivity, %, (95% CI)	Specificity, %, (95% CI)	AUC, %, (95% CI)
CADe	82.2 (79.7 - 84.5)	74.7 (70.9 - 78.1)	87.2 (79.9 - 94.5)
CAQ + CADe	89.9 (87.2 - 92.1)	74.7 (70.0 - 78.9)	91.4 (82.0 - 100)

Conclusion

This study introduces the first CAQ system specifically aimed at automated quality control in BE endoscopy. As a standalone tool, the system effectively distinguishes poorly from well-visualized mucosa. When combined with an established CADe system, it enhances detection rates for neoplasia, highlighting its potential to improve diagnostic accuracy in BE surveillance.