1. 53 y/o Upper abd pain/burning, reflux 9/2011 – EGD – polypoid lesion in stomach on EGD, started on omeprazole – Path – carcinoid, invasive to muscularis, metaplasia

2. 10/2011 Hampton VA GI – EGD – several polypoid lesions, 1 lesion ulcerated, – Biopsy – carcinoid – Heme/Onc, Surgery evals 2/2012 Hampton – Attempted endoscopic resection Masses 2cm, 5cm, 8cm from GEJ 4/2012 Richmond VA

3. PMH/PSH: none Meds: omeprazole Social: ½ PPD tobacco, quit drugs/EtOH 4 years ago

4. 5/8 – Exploration – gastrectomy Path – GEJ carcinoids, posterior wall – 0/10 nodes – 2.1 cm – Well differentiated, into muscularis

6. Type 1 – associated with atrophic gastritis Type 2 – sporatic Type 3 – associated with gastrinoma, MEN1 (type 2 in other system) Type 4 – other endocrine carcinomas or mixed tumors

10. Survival Type 1 – 5y=96.1%, 10y=73.9% Type 2 – 5y=95%+ Type 3 – 5y=50-75% Type 4 – 5y=33%, 10y=22%

13. Treatment recommendations Type 1- endoscopic removal of 5 lesions up to 10mm antrectomy for >5 lesions to 10mm lesions >10mm require surgical removal serosal involvement or spread outside stomach – gastrectomy Type 2- treat gastrinoma, endoscopic 10mm Type 3,4- laparotomy, local excision Treatment recommendations Type 1- EMR of 5 lesions up to 10mm, confined to submucosa, confirm neg margins EGD every 6-12m recurrence – surgical resection based on extent of disease consider antrectomy – some support in literature lesions>10mm/more invasive – wedge resection, subtotal/total gastrectomy based on extent of disease case reports of octreotide use in non-surgical candidates Type 2- treat gastrinoma, endoscopic 10mm Type 3- laparotomy, total or near total gastrectomy, node dissection (more aggressive)

14. Treatment recommendations Type 1- EMR, polypectomy of 5 lesions up to 10mm, confined to submucosa consider antrectomy – some support in literature consider observation/repeat EGD lesions<10mm case reports of octreotide use in non-surgical candidates Type 2- treat gastrinoma, endoscopic <10mm Type 3- laparotomy, total or near total gastrectomy, node dissection (more aggressive)