title: Endoscopic submucosal dissection (ESD) for gastrointestinal carcinoid tumors.
abstract: BACKGROUND
  Gastrointestinal (GI) carcinoid tumors less than 10 mm in diameter and limited to the submucosal layer demonstrate a low frequency of lymph node and distant metastasis; endoscopic submucosal dissection (ESD) has been used to treat these tumors. However, the number of reported sample cases of rectal carcinoid tumors treated with ESD remains insufficient, and the safety and efficacy of ESD for gastric and duodenal carcinoid tumors have not been elucidated to date.
  
  
  METHODS
  From January 2004 to March 2011, a series of 42 gastrointestinal carcinoid tumors (37 rectal, 2 gastric, and 3 duodenal) in 41 consecutive patients were treated with ESD. Therapeutic efficacy, complications, and follow-up results were retrospectively evaluated.
  
  
  RESULTS
  Sessile type (type Is) was the most prevalent lesion. Mean procedural time was 41 ± 20 min. The mean sizes of tumors and resected specimens were 5 ± 3 mm and 19 ± 7, respectively. The overall rate of en bloc resection was 100% (42/42). Postoperative bleeding occurred in two rectal cases (5%), which were successfully managed with endoscopic clipping. Perforation occurred in two duodenal cases, which could be conservatively managed with medical treatment after endoscopic clipping, and neither laparoscopy nor emergent surgery was needed. No recurrence was observed during the mean follow-up period of 37 months.
  
  
  CONCLUSIONS
  ESD was a safe and effective endoscopic treatment for rectal and gastric carcinoid tumors, although other treatment modalities were desirable for duodenal carcinoid tumors.
authors: Department of Gastroenterology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
authors: Shoko
authors: S
authors: Suzuki
authors: Naoki
authors: N
authors: Ishii
authors: Masayo
authors: M
authors: Uemura
authors: Gautam A
authors: GA
authors: Deshpande
authors: Michitaka
authors: M
authors: Matsuda
authors: Yusuke
authors: Y
authors: Iizuka
authors: Katsuyuki
authors: K
authors: Fukuda
authors: Koyu
authors: K
authors: Suzuki
authors: Yoshiyuki
authors: Y
authors: Fujita
mesh_terms: D000328:Adult; D000368:Aged; D002276:Carcinoid Tumor / Q000601:surgery*; D004210:Dissection / Q000379:methods; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000601:surgery*; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome