P2748 - An Experience of Endoscopic Band Ligation Without Resection (EBL-WR) for Grade One, Well Differentiated Duodenal and Rectal Carcinoid Tumors

Daniyal Abbas, MD, Kara Regan, MD, Prashant Mudireddy, MD
East Carolina University, Greenville, NC

Introduction: Gastrointestinal neuroendocrine tumors (GI-NETs) are rare but their incidence and prevalence have been increasing. The majority of the GI-NETs are non-functioning. Gastrointestinal carcinoids are generally diagnosed and staged by endoscopy with biopsy, serology of biomarkers, endoscopic ultrasound, imaging studies and functional somatostatin scans. Treatment and prognosis depend on the grade and stage of the tumor. The objective of our study is to assess the outcomes in patients with small (< 1 cm), grade 1 and well differentiated gastrointestinal neuroendocrine tumors who underwent endoscopic band ligation without resection (EBL-WR).

Methods: Retrospective chart review of electronic health records from 2017 - 2021 at a tertiary medical center. Fourteen patients who underwent EBL-WR for grade 1, well-differentiated neuroendocrine tumors in the duodenum and rectum were included. EUS was used to stage the NET. Multi-Band mucosectomy device was used for banding. Repeat endoscopies were performed at an interval of 46- 414 days. Biopsies were performed on repeat intervention to assess for recurrence at the scar site. IRB approval was obtained from the East Carolina University.

Results: Of the 14 patients included in this study, 6 were male and 8 were female. Biopsy was performed prior to intervention in all cases and demonstrated a low-grade, well-differentiated neuroendocrine tumor. EUS exam was done prior to EBL-WR in all patients. The lesion size was 5-10 mm in 9 patients, 1-5 mm in 2 patients, and 10-15 mm in one patient. 11 patients had a NET in the duodenum and 3 patients in the rectum. Successful banding was achieved in all patients and there were no immediate or delayed procedural complications. One patient had evidence of recurrence.

Discussion: The treatment of choice for early GI-NETs is endoscopic resection with surveillance. Our study showed that EBL-WR is safe and effective in the management of GI-NETs less than 1 cm. This technique essentially eliminates the risk of bleeding and perforation when compared to standard endoscopic resection.


Figure: Figure 1. Endoscopic appearance of GI- NET with EBL-WR

Patient	Age	Charlson Comorbidity index	Location of NET on endoscopy	Size in mm	Tumor Grade and Differentiation	Layers on EUS	Follow up interval on Endoscopy
1	73	5	Duodenum	4mm x 2mm	Grade 1, Well differentiated	Mucosa, submucosa	n/a
2	59	4	Duodenum	3mmx2mm	Grade 1, Well differentiated	Mucosa, submucosa	143 d
3	83	5	Duodenum	12mm single carcinoid	Grade 1, Well differentiated	Mucosa, submucosa	n/a
4	69	3	Duodenum	8mm x 6 mm	Grade 1, Well differentiated	Mucosa, submucosa	n/a
5	60	5	Duodenum	8 mm x 3mm	Grade 1, Well differentiated	Mucosa, submucosa	75-367d
6	59	2	Rectum	n/a	Grade 1, Well differentiated	n/a (prior resection)	n/a
7	42	4	Duodenum	7 mm x 6 mm	Grade 1, Well differentiated	Submucosa	130-334d
8	57	6	Duodenum	8-10mm	Grade 1, Well differentiated	n/a	173d
9	67	6	Rectum	10 mm	Grade 1, Well differentiated	Submucosa	153d
10	82	6	Duodenum	5-10mm	Grade 1, Well differentiated	Mucosa, submucosa	n/a
11	59	4	Duodenum	8mm	Grade 1, Well differentiated	Mucosa, submucosa	46-87d
12	57	4	Rectum	n/a	Grade 1, Well differentiated	n/a (prior resection)	115d
13	64	2	Duodenum	8mm x 6mm	Grade 1, Well differentiated	Mucosa, submucosa	196d
14	71	4	Duodenum	6mm	Grade 1, Well differentiated	Mucosa, submucosa	231-414d

Table: Table 1.


Disclosures:
Daniyal Abbas indicated no relevant financial relationships.
Kara Regan indicated no relevant financial relationships.
Prashant Mudireddy indicated no relevant financial relationships.


Daniyal Abbas, MD, Kara Regan, MD, Prashant Mudireddy, MD. P2748 - An Experience of Endoscopic Band Ligation Without Resection (EBL-WR) for Grade One, Well Differentiated Duodenal and Rectal Carcinoid Tumors, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.