Endoscopic Ultrasound Evaluation Does Not Predict Success of Endoscopic Resection of Duodenal Carcinoids

Abstract

Purpose: Endoscopic Ultrasound (EUS) is routinely used to evaluate the depth of submucosal lesions, such as carcinoid tumors, prior to endoscopic mucosal resection (EMR). The purpose of this study is to evaluate whether EUS findings of duodenal carcinoids correlated with complete or incomplete endoscopic resection. Methods: The medical records of patients in whom carcinoid tumors were endoscopically resected from the duodenal bulb from the year 2000 to 2010 were retrospectively reviewed. Patient demographics, endoscopic ultrasound (EUS) evaluation, type of resection technique, adequacy of resection (from pathology reports), specimen sizes, and complications were recorded. Resection techniques included suck-and-ligate, inject-and-snare, and snare-alone. Results: A total of 30 lesions were resected. EUS evaluation was performed in 27, with 24 performed on the same day as resection. The three EUS evaluations not performed on the same day as the resection were performed 11 days, 1.5 months, and 2 months prior to resection. 24 cases demonstrated no adherence of the lesion with the muscularis propria or other evidence of disease spread. 8 of these 24 cases (33.3%) were found to have positive margin involvement by pathology. Of these eight, 7 involved the deep margin while the site of margin involvement of the remaining lesion was not clear in the pathology report. There were three cases in which lesion adherence to the muscularis propria was suspected, and all three had positive margins by pathology. There were no complications in any of the procedures. Conclusion: EUS did not predict complete resection of duodenal carcinoid tumors from the duodenal bulb as 1/3rd of lesions believed to be localized to the submucosa were found to have positive margin involvement on pathology (7 of which involved deep margins). Though complete resection could not be positively predicted by EUS, lesions suspicious for involvement with the muscularis propria were correctly predicted as being unable to be completely resected by EMR.Table: No Caption available.