Endoscopic resection of duodenal bulb neuroendocrine tumor larger than 10 mm in diameter

Abstract

BackgroundEndoscopic treatment for duodenal bulb neuroendocrine tumor larger than 10 mm is still controversial. This report presents four cases successfully treated with endosonography (EUS)-assisted endoscopic mucosal resection (EMR) procedure for duodenal bulb neuroendocrine tumor larger than 10 mm in diameter.MethodsThe case series of four patients diagnosed with neuroendocrine tumor from 2003 to 2008 were reviewed. EUS demonstrated well-defined hypoechoic tumors confined to the submucosal hyperechoic layer and the underlying hypoechoic muscularis propria was intact in all four patients. EMR were planned and performed for the duodenal bulb neuroendocrine tumors larger than 10 mm.ResultsEn bloc resections with tumor free lateral and basal margins were accomplished using an endoscopic diathermic snare with forward-viewing instruments without any complications. Neither residual duodenal neuroendocrine tumors nor metastatic lesions were detected during the observation period ranging 19 to 78 monthsConclusionDuodenal bulb neuroendocrine, larger than 10 mm in diameter, can be treated by endoscopic procedure, after confirming that the tumor confined to the submucosal layer in EUS examination, and no lymph node involvement by abdominal CT and US.

Endoscopic Banding for Duodenal Carcinoid Tumors

“…1,2 Duodenal carcinoids accounting for only 2% of all small intestinal carcinoids. 1,3 They are seen with decreasing frequency from the first to the third part of the duodenum. 1,2 An association of duodenal carcinoids has been described with the Zollinger-Ellison syndrome and with multiple endocrine neoplasia, (MEN) type I.…”

“…Periampullary carcinoids appear to have a distinctly different, more aggressive biology, with nodal involvement and metastases being unrelated to tumor size or mitotic activity. [1][2][3] These tumors are hence considered separately from other duodenal carcinoid tumors. Most of the duodenal carcinoids are clinically silent, but they may present with vague abdominal pain, vomiting as was the case with our patient.…”

“…1,3,4 Recently, endoscopic treatment such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (EMD) has been attempted as an alternative to conventional surgery. [3][4][5][6][7] The aim of this report is to explore the possibility of endoscopic banding and resection of small duodenal carcinoids, thereby avoiding the morbidity associated with conventional foregut surgery. This report to our knowledge is the only the second such report of endoscopic banding for duodenal carcinoids in English medical literature.…”

“…1,2 Even though they have an indolent course, resection is generally recommended due to the risk of lymph node involvement and metastases. 1,3 Most cases of duodenal carcinoid have conventionally been treated by major surgical resections like a duodenal resection or even a Whipple's procedure. 1,3,4 Recently, endoscopic treatment such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (EMD) has been attempted as an alternative to conventional surgery.…”

“…1,3 Most cases of duodenal carcinoid have conventionally been treated by major surgical resections like a duodenal resection or even a Whipple's procedure. 1,3,4 Recently, endoscopic treatment such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (EMD) has been attempted as an alternative to conventional surgery. [3][4][5][6][7] The aim of this report is to explore the possibility of endoscopic banding and resection of small duodenal carcinoids, thereby avoiding the morbidity associated with conventional foregut surgery.…”