Endoscopic resection using an over-the-scope clip for duodenal neuroendocrine tumors

Abstract

Background and study aims Endoscopic resection of duodenal neuroendocrine tumors (DNETs) remains controversial, and its indications are still unclear. This study aimed to evaluate short-term outcomes of a newly developed endoscopic muscularis resection (EMR) method that utilizes an over-the-scope clip (OTSC), termed EMRO, for treating DNETs. Patients and methods In total, 13 consecutive patients with 14 small (≤ 10 mm) DNETs who underwent EMRO from September 2017 to March 2020 were retrospectively enrolled. EMRO was performed by a single experienced endoscopist. Patients’ characteristics and treatment outcomes were assessed. Results The En bloc and R0 resection rates were 100 % (14/14) and 92.9 % (13/14), respectively. The median pathological resected specimen size was 10 mm, with a median pathological resected tumor size of 6 mm. During the EMRO procedure, there was no occurrence of misplacement of the OTSC to the target lesion. With respect to the pathological resection depth, nine cases (64.3 %) and five cases (35.7 %) were categorized as deep submucosal resection and muscularis resection, respectively, whereas no case was categorized as full-thickness resection. There were no intraoperative or delayed perforations. However, delayed bleeding occurred in two cases. At a median follow-up of 12 months (range 7–36) after EMRO, there was no incidence of local recurrence. At the first follow-up endoscopy performed at 6 months after EMRO, the OTSC was retained in place in two of 14 DNETs (14.3 %). Conclusions EMRO can be performed safely, by an experienced endoscopist, for small (≤ 10 mm) DNETs.

Issues and Prospects of Current Endoscopic Treatment Strategy for Superficial Non-Ampullary Duodenal Epithelial Tumors

“…Deployment of an OTSC was followed by full-thickness resection, which was performed inside the OTSC by snare. The en-bloc resection and R0 resection rates were relatively high (80–100% and 80–92.9%, respectively) without increasing the AE rate; EFTR might be an option when lesions are difficult to resect with ESD if the patient is unable to undergo invasive surgery with general anesthesia [ 24 , 25 , 26 ].…”

Flat-based over-the-scope clip-assisted endoscopic full-thickness resection of a duodenal neuroendocrine tumour: a safe alternative to endoscopic submucosal dissection

“…Here, we demonstrate endoscopic full-thickness resection (EFTR) using the Padlock clip defect closure system as an alternative technique for en bloc resection of a duodenal neuroendocrine tumor (NET) of < 1.5 cm. Most of the previous literature has reported the use of the Ovesco over-the-scope clip system or the new full-thickness resection device for resection of NETs within the duodenum 2 3 4 . To the best of our knowledge, this is the first case to be reported in which the padlock system was used for EFTR of a NET > 10 mm in size.…”

Over-the-scope clip-assisted endoscopic full-thickness resection has potential to treat complex nonampullary duodenal lesions: a single-center case series

“…OTSC-assisted EFTR is a “close-then-cut” nonexposed EFTR that is safer than “cut-then-close” EFTR in that the former avoids contamination of gastrointestinal luminal content into the peritoneum. There have been only a few case reports about OTSC-assisted duodenal tumor EFTR followed by resection of a pseudopolyp using snare resection or a needle knife (Table 1 ) [ 4 , 10 – 18 ]. Most of the case reports published in the past were technical exploratory treatments for non-difficult lesions; thus, conventional ESD or EMR may still have a high success rate.…”

“…A few case reports and case series have been published on the first two EFTR methods [ 5 , 9 ], but successful OTSC-assisted EFTR in duodenal lesions has been published in few reports to date—approximately 31 cases in total (Table 1 ) [ 10 – 18 ], and most of these studies were exploratory attempts to treat non-difficult lesions; thus, conventional ESD or EMR may still have a high success rate. Here, we report 13 case series of OTSC-assisted EFTR for complex nonampullary duodenal lesions (with nonlifting signs, incomplete lifting signs, difficult location, suspected origin in the muscularis propria or failed ESD/EMR attempts) at our medical center.…”