2155 A Minimally Invasive Approach to Resection of a Duodenal Neuroendocrine Tumor Using the Full-Thickness Resection Device

Abstract

INTRODUCTION: The Full-Thickness Resection Device (FTRD) allows for diagnostic and therapeutic endoscopic full-thickness resection (EFTR) of lesions that are unresectable with conventional endoscopic techniques. The device offers a minimally invasive approach to full thickness resection of intestinal and rectal lesions, and ensures safe tissue closure with over-the-scope-clip (OTSC) technology. We report a patient in whom the FTRD system was used for R0 resection of a duodenal neuroendocrine tumor. CASE DESCRIPTION/METHODS: A 68 year-old-male with history of Barrett’s esophagus was found to have a low-grade neuroendocrine tumor of the duodenal bulb on surveillance upper endoscopic screening. Computed tomography (CT) imaging of the abdomen revealed a hypervascular duodenal bulb mass, without obvious extension to the wall, lymphadenopathy, or evidence of metastasis. Endoscopic ultrasound (EUS) with fine needle aspiration (FNA), revealed a 1.2 cm mass arising from the submucosal layer with pathology indicating a low-grade neuroendocrine tumor. Due to the small tumor size, EFTR by FTRD was planned. Upon advancing the endoscope with the FTRD system attached, a non-bleeding neuroendocrine tumor was visualized (Figure 1). The mass was carefully pulled into the cap and after banding, ligation and cutting; there was a full thickness en bloc resection with all layers of the duodenum apparent (Figure 2). Pathology of the specimen documented a grade 2 neuroendocrine tumor with clean margins, confirming R0 resection (Figure 3). The patient was discharged the same day without associated complications. DISCUSSION: Upper gastrointestinal endoscopy and histologic examination are essential for diagnosis of duodenal neuroendocrine tumors, and EUS should follow for determination of size and depth of infiltration as well as determination of locoregional lymph node involvement. Multiple factors, such as tumor size, location, and grade need to be considered when determining treatment options. The FTRD system offers a novel endoscopic treatment approach to tumors extending beyond the submucosa that require full thickness resection and would otherwise require higher risk surgical intervention. The technology allows for safe tissue closure, valid histologic evaluation of the en-bloc specimen, and minimal thermal injury, thus reducing the morbidity and cost otherwise associated with surgery. Our case illustrates the successful R0 resection of a T2, grade 2 neuroendocrine tumor using the FTRD.