Endocrine (2015) 49:867–868 DOI 10.1007/s12020-015-0617-7

LETTER TO THE EDITOR

Clinical management of patients with gastric neuroendocrine neoplasms associated with chronic atrophic gastritis Philippe Guillem1 • Virginie Vlaeminck-Guillem2,3

Received: 15 April 2015 / Accepted: 22 April 2015 / Published online: 10 May 2015  Springer Science+Business Media New York 2015

To the Editor, We read with great attention the paper recently published in Endocrine by Campana et al. about type I gastric neuroendocrine neoplasms (gNENs, ‘gastric carcinoids’) [1]. We would like to recall antrectomy as a therapeutic option that the authors did not experience in their 97-patient study and did not discuss in their manuscript. As stated, type I gNENs are gastrin-dependent, and consequently several authors have previously reported successful long-term management with surgical resection of the gastrin-producing antral tissue [2, 3]. A therapeutic test using somatostatin analog therapy has also been advocated as a way to evaluate whether antrectomy will be effective or not [3]. Hypergastrinemia has been proven to be resolved following antrectomy, and endoscopy-proven regression of gNENs has been observed in almost all patients within the postoperative months [2]. Campana et al. confirmed that somatostatin analog therapy can be considered as a successful therapy for type I gNENs but seems to require a long

& Virginie Vlaeminck-Guillem [email protected] 1

2

3

Surgical Department, Clinique du Val d’Ouest, Chemin de la Vernique, 69130 E´cully, France Biochemistry and Molecular Biology, Lyon-Sud University Hospital, Hospices Civils of Lyon, Chemin du Grand Revoyet, 69495 Pierre-Be´nite, France University of Lyon, Cancer Research Centre of Lyon, INSERM1052, CNRS5286, Lyon I University, Le´on Be´rard Centre, 28 rue Laennec, 69008 Lyon, France

period of treatment. They also recalled the high cost of this therapeutic option [1]. We suggest that antrectomy can be considered as an interesting alternative, since it has definitively proven to be successful in normalizing hypergastrinemia and less expensive, without requiring iterative several year-long subcutaneous injections. As every drug use is associated with side-effects, antrectomy is obviously associated with per- and postoperative complications, which notably depend on whether or not a Roux-en-Y gastrojejunostomy is used, and include specific surgical complications (such as bleedings, fistulas, wound infections, anastomosis stenosis…), functional disturbances (such as postprandial fullness) as well as nonspecific medical complications (phlebitis, pneumonia…). The laparoscopic approach is likely to be a means by which such morbidity can be reduced [3]. Patient’s comorbidities and life expectancy should also be taken into account as the criteria to best adapt the therapeutic choice between antrectomy and somatostatin analog therapy. As underlined by Campana et al., there is a need for prospective randomized trials and specific cost-effectiveness studies to better delineate therapeutic indications. We assume that antrectomy should be included as part of these evaluations.

Conflict of interest

The authors declare no conflict of interest.

References 1. D. Campana, D. Ravizza, P. Ferolla, A. Faggiano, F. Grimaldi, M. Albertelli, D. Berretti, D. Castellani, G. Cacciari, N. Fazio, A. Colao, D. Ferone, P. Tomassetti, Clinical management of patients with gastric neuroendocrine neoplasms associated with chronic atrophic gastritis: a retrospective, multicentre study. Endocrine (2015). doi:10.1007/s12020-015-0584-z

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868 2. P. Guillem, V. Vlaeminck-Guillem, E. Leteurtre, R. Kornhauser, A. Cortot, J.L. Wemeau, J.P. Triboulet, Fundic endocrine tumors and atrophic gastritis: the value of antrectomy. Gastroenterol. Clin. Biol. 26(8–9), 782–785 (2002)

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Endocrine (2015) 49:867–868 3. S. Rustagi, J. Yao, R.R. Warner, C.M. Divino, Laparoscopic antrectomy for retained antrum in type 1 gastric carcinoid: a case report and review of literature. Pancreas 42(6), 1040–1042 (2013). doi:10.1097/MPA.0b013e31827e2d3b

Clinical management of patients with gastric neuroendocrine neoplasms associated with chronic atrophic gastritis.

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