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Duodenal Neuroendocrine Tumors
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Valentina Andreasi, Stefano Partelli, Francesca Muffatti, Massimo Falconi
The vast majority of duodenal neuroendocrine neoplasms (90%) are non-functioning. Therefore, most of these tumors are incidentally detected during upper gastrointestinal endoscopy. A functional clinical syndrome can be observed when hormonal hypersecretion is present. Symptoms related to Zollinger-Ellison syndrome are present in about 10% of cases, whereas carcinoid syndrome occurs rarely (3%) [1]. Duodenal neuroendocrine neoplasms may be sporadic or genetically determined, when associated with multiple endocrine neoplasia type 1 [2].
Decision analysis and decision-making in medicine: Beyond intuition, guts and flair
Published in Milos Jenicek, Foundations of Evidence-Based Medicine, 2019
New laboratory techniques are constantly appearing. As an example, patients with suspected Zollinger-Ellison syndrome should be evaluated either by an initial gastric analysis (elevated serum gastrin values) alone, or by an added secretion infusion test. Is such a costly addition worth it? Does it improve clinical decision-making? More importantly, how will it affect the patient's health and outcome? Should gastric analysis first be performed, followed by a secretin infusion test? Would such testing obviate unnecessary hospitalization and medical costs?2,3 In the above-mentioned cases, the patient's health and life are at stake. Additional tests are usually costly, thus the best possible and most cost-effective decisions should be made given the circumstances.
Gastroenterology and hepatology
Published in Shibley Rahman, Avinash Sharma, A Complete MRCP(UK) Parts 1 and 2 Written Examination Revision Guide, 2018
Shibley Rahman, Avinash Sharma
Zollinger-Ellison syndrome is a condition characterised by excessive levels of gastrin, usually from a gastrin-secreting tumour of the duodenum or pancreas. Around 30% occur as part of MEN type I syndrome.
Efficacy and safety of endoscopic submucosal dissection for gastrointestinal neuroendocrine tumors: a 10-year data analysis of Northern China
Published in Scandinavian Journal of Gastroenterology, 2019
Xin Chen, Bianxia Li, Saiyu Wang, Bo Yang, Lanping Zhu, Shuang Ma, Jingyi Wu, Qijin He, Jingwen Zhao, Zhongqing Zheng, Shu Li, Tao Wang, Li Liang
Gastric neuroendocrine tumors (G-NETs) are classified into three distinct types [5]: type 1 and 2 are associated with chronic atrophic gastritis (CAG) and gastrin-secreting neoplasms in Zollinger–Ellison syndrome (ZES)/multiple endocrine neoplasia (MEN) 1, respectively. They are small (<1–2 cm), multiple and taken as benign generally. Type 1 G-NETs account for 70–80% of all G-NETs, located in fundus or corpus of stomach and limited to mucosa or submucosa with an excellent prognosis. Type 2 G-NETs are rare, constituting 5–6% of all G-NETs, but the clinical prognosis is not as good as type 1 G-NETs patients due to the gastrinoma [6]. Type 3 G-NETs mostly present as large and sporadic lesions, which account for 14–25% of all G-NETs with a high risk of metastasis and poor prognosis. Duodenal neuroendocrine tumors (D-NETs) usually appear to have a relatively less incidence than gastric and rectal NETs, accounting for about 5% of GI-NETs, which are generally confined to the mucosa or submucosa [7]. About 80% of rectal neuroendocrine tumors (R-NETs) are small (<1 cm), solitary, confined to the submucosa with a good prognosis, but occasionally multiple. In addition to the size of the lesion, lymph node metastasis is usually closely related to the R-NETs endoscopic characteristics [8].
Relationship between body mass index, waist circumference, waist hip ratio and erosive gastroesophageal reflux disease in a tertiary centre in Nigeria: A case control study
Published in Alexandria Journal of Medicine, 2018
Olusegun Adekanle, Samuel Anu Olowookere, Oluwasegun Ijarotimi, Dennis Amajuoyi Ndububa, Akinwumi Oluwole Komolafe
Gastro-oesophageal reflux disease (GERD) is a condition that develops when the reflux of stomach content causes troublesome symptoms with or without mucosa damage and or complications. At upper gastro-intestinal endoscopy, GERD may be erosive (when there is visible erosions) or non-erosive (when there is no visible mucosa erosion). Heartburn and regurgitation are typical symptoms of reflux experienced by patients.1,2 GERD is one of the most prevalent clinical conditions affecting the gastro-intestinal tract. Associated conditions that have been established to occur with GERD include the Zollinger Ellison syndrome (ZES) and connective tissue disease like scleroderma.3 Central obesity has been fairly reasonably shown from studies outside Nigeria to be associated with GERD.4–8 Among patients with obesity, studies have shown that central deposition of fat relates more to reflux symptoms than peripheral deposition of fat.9 Other conditions that have been shown to be associated with GERD include pregnancy, cigarette smoking, and the use of drugs like the nitrates, calcium channel blockers, beta blockers and aminophylline.10 Surgical destruction of the lower oesophageal sphincter or balloon dilatation also renders the gastro-esophageal valve incompetent.10 Few studies have shown an association between GERD and central obesity in Nigeria and many of these are questionnaire based with only one or so that was based on diagnostic upper gastro-intestinal endoscopy.
Duodenal neuroendocrine neoplasms: a still poorly recognized clinical entity
Published in Scandinavian Journal of Gastroenterology, 2018
Roberta Elisa Rossi, Emanuele Rausa, Federica Cavalcoli, Dario Conte, Sara Massironi
DNENs are usually present in the 6th decade of age and there is a slight male predominance (1.5/1 in the latest SEER data set) [6]. In 50–70% of the cases, dNENs are well-differentiated forms (G1 according to WHO 2010), whilst poorly differentiated tumors are rare (less than 3%) [7]. They include functioning (i.e., gastrinoma (48%) and somatostatinoma (44%)) and non-functioning serotonin (28%) and calcitonin (9%)-containing tumors, rare duodenal gangliocytic paragangliomas, and high-grade poorly-differentiated neuroendocrine carcinomas [2,8,9]. DNENs arise more frequently in the first (58%) and second part (33%) of the duodenum, whilst tumors located in the ampulla of Vater (approximately 20%) are often considered as a separate entity because of their clinical behavior, which is more similar to pancreatic tumors [9–15]. They are usually small (>75% of them range from 1.2 to 1.5 cm up to 2 cm), limited to the mucosa and submucosa, although regional lymph node metastases are reported to be present in 40–60% of cases at first diagnosis [7,8]. Liver metastases occur in less than 10% of patients [9]. In cases of multiple dNENs, multiple endocrine neoplasia type 1 (MEN1) should be suspected [2,16,17]. MEN1 occurs in 20–30% of all dNEN patients with Zollinger–Ellison syndrome (ZES) [18–20].