Endoscopic resection with the cap technique of a carcinoid tumor in the duodenal bulb

Karagiannis, Stefanos; Eshagzaiy, K.; Duecker, C.; Feyerabend, Bernd; Mozdzanowski, E.; Faiss, S

doi:10.1055/s-0029-1215123

Cited by 18 publications

(17 citation statements)

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“…4,5 In the study on gastric, duodenal, and rectal carcinoid tumors conducted by Yoshikane et al, 2 the tumors were visualized as hypoechoic lesions in most cases. The accuracy of determination of the depth of invasion by EUS was 90% (27 of 30 lesions) for the tumors overall, and 80% (4 of 5 lesions) for duodenal carcinoid tumors (excluding papillary tumors).…”

Section: Discussionmentioning

confidence: 99%

“…5,14 Moreover, there is even a case report on EMR of a 12-mm duodenal carcinoid tumor. 1 In contrast, ESD for the duodenal lesions is technically difficult and the duodenal wall is thin; therefore, duodenal ESD requires a long resection time and has a high risk of perforation.…”

Section: Discussionmentioning

confidence: 99%

“…According to the general guidelines for the treatment of duodenal carcinoid tumors, endoscopic therapy is recommended for tumors measuring less than 1 cm in diameter, whereas surgical resection may be preferable for those measuring 1 cm or more 1 ; however, no consensus has been reached as yet on this subject. With regard to endoscopic therapy, although there are scattered reports of endoscopic resection of duodenal carcinoid tumors, [1][2][3][4][5] no report has been published yet on endoscopic submucosal dissection (ESD) of these tumors. Whether ESD can be performed safely has not yet been investigated.…”

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confidence: 99%

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Duodenal carcinoid tumors: 5 cases treated by endoscopic submucosal dissection

Matsumoto¹,

Matsuda²,

Yoshida³

2011

Gastrointestinal Endoscopy

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Duodenal carcinoid tumors: 5 cases treated by endoscopic submucosal dissection

Matsumoto¹,

Matsuda²,

Yoshida³

2011

Gastrointestinal Endoscopy

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“…Endoscopic resection is feasible for carcinoids <1 cm and possibly up to 2 cm in diameter. EUS assessment is required prior to resection to ensure that the lesion does not involve the muscularis propria [Ahmad et al 2002;Dalenback and Havel, 2004;Karagiannis et al 2009;Pungpapong et al 2006;Shim and Jung, 2005;Urso et al 2007;Zyromski et al 2001]. The risk of perforation and bleeding can be high due to the submucosal origin of carcinoids, plus the rich vascular supply and thin wall of the duodenum.…”

Section: Submucosal Lesionsmentioning

confidence: 99%

Endoscopic management of nonampullary duodenal polyps

Basford

Bhandari

2011

Therap Adv Gastroenterol

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Duodenal polyps are a rare finding in patients presenting for gastroscopy, being found in 0.3-4.6% of cases. The majority of patients are asymptomatic. The most common lesions necessitating removal are duodenal adenomas which should be differentiated from other mucosal lesions such as ectopic gastric mucosa, and submucosal lesions such as carcinoids and gastrointestinal stromal tumours (GISTs). Adenomas can occur sporadically or as part of a polyposis syndrome. Both groups carry malignant potential but this is higher in patients with a polyposis syndrome. The majority of sporadic duodenal adenomas are flat or sessile and occur in the second part of the duodenum. Historically duodenal adenomas have been managed by radical surgery, which carried significant mortality and morbidity, or more conservative local surgical excision which resulted in high local recurrence rates. There is growing evidence for the use of endoscopic mucosal resection (EMR) techniques for treatment of sporadic nonampullary duodenal adenomas, with good outcomes and low complication rates. Endoscopic submucosal dissection (ESD) carries greater risk of complications and should be reserved for experts in this technique. Patients with sporadic duodenal adenomas carry an increased risk of colonic neoplasia and should be offered colonoscopy. The impact of endoscopic resection on the course of polyposis syndromes such as familial adenomatous polyposis (FAP) needs further study.

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“…Tumors in the submucosa outside of the periampullary area that are up to 1 cm without lymph nodes metastases on EUS or CT and no mitotic figures exhibit indolent behavior and no metastases. In these cases, endoscopic removal is the suitable treatment (6,9,25) . An endoscopic resection of the lesion was the initial treatment in nine (45%) patients who had a tumor smaller than 1.0 cm.…”

Section: Discussionmentioning

confidence: 99%

Carcinoid Tumor of the Duodenum:

Waisberg

Joppert-Netto

Vasconcellos

et al. 2013

Arq. Gastroenterol.

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ContextDuodenal carcinoids are extremely rare, and their characteristics and biological behavior have not been fully elucidated.ObjectiveTo analyze the clinicopathological characteristics of patients with resected duodenal carcinoids.MethodsTwenty patients (12 females and 8 males) were investigated. Their average age was 66.4 ± 5.8 years old (43 to 88 years old). The data corresponding to the clinical picture, diagnosis, treatment, and prognosis of patients with duodenal carcinoid tumors subjected to resection over a period of 18 years (1993-2011) were analyzed.ResultsThe most common symptoms were dyspepsia (50%) and epigastric pain (45%) followed by weight loss (10%) and vomiting (5%). Carcinoid syndrome was not observed in any patient. The lesion was located on the first part of the duodenum in 15 (75%) patients, the second part in 4 (20%) patients, and the third part in 1 (5%) patient. The diagnosis of a carcinoid tumor was established through an endoscopic excision biopsy in 19 (95%) patients and an histopathological examination of the surgical specimen in 1 (5%) patient. The average tumor size was 1.1 cm ± 0.4 cm (0.3 cm to 6.0 cm). Nineteen (95%) patients were initially treated by endoscopic resection of the duodenal lesion. One patient (5%), whose tumor was on the third part of the duodenum underwent a duodenectomy of the third and fourth duodenal parts and duodenojejunal anastomosis. The duodenal carcinoid resection margin was involved in four (20%) patients. Four (20%) patients were subjected to a partial gastrectomy to fully remove the lesion. The tumor was restricted to the submucosal layer in 16 (80%) cases, and it penetrated into the muscular layer in 4 (20%) cases. All patients exhibited positive chromogranin A, neuron-specific enolase, and/or synaptophysin immunostaining. The average duration of the follow-up period was 39.6 months (3 to 96 months). Twelve (60%) of the 20 cases in this series are alive without any evidence of active disease. Only one (5%) patient died due to liver metastases of the duodenal carcinoid.ConclusionsDuodenal carcinoids are rare and indolent tumors usually associated with a benign progression. Duodenoscopy, computerized tomography, and endoscopic ultrasound should be performed to evaluate the tumor size, the level of wall invasion, and the presence of regional or distant lymphatic metastases. Endoscopic removal of tumors smaller than 1.0 cm without periampullary localization or evidence of muscular propria layer invasion assessed by histology and/or endoscopic ultrasound is recommended. The endoscopic resection with a carcinoid tumor size between 1.0 cm and 2.0 cm can be incomplete and require new endoscopic resection or even surgical removal. Duodenal carcinoid larger than 2.0 cm require full-thickness resection and concomitant lymphadenectomy.

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Endoscopic resection with the cap technique of a carcinoid tumor in the duodenal bulb

Cited by 18 publications

References 1 publication

Duodenal carcinoid tumors: 5 cases treated by endoscopic submucosal dissection

Duodenal carcinoid tumors: 5 cases treated by endoscopic submucosal dissection

Endoscopic management of nonampullary duodenal polyps

Carcinoid Tumor of the Duodenum:

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