Ligation assisted endoscopic mucosal resection of neuroendocrine tumor of duodenal bulb: a case report with a follow up of 24 months

Gopi Aryal,Umid Kumar Shestha

doi:10.3126/jaim.v8i1.28001

Abstract

Duodenal neuroendocrine tumor (NET) is a rare solitary lesion arising from the mucosa and submucosa of the duodenum, which is found incidentally during upper gastrointestinal endoscopy. Eendoscopic Mucosal Resection (EMR) has been the commonly used endoscopic procedure for duodenal carcinoid tumors, but the conventional EMR done to resect duodenal NET s is likely to have positive vertical margins. However, the ligation assisted EMR has recently been shown to be a promising technique for the treatment of duodenal NET that can have a negative free margin. In our study, we present a patient of 51-year-old male, who presented with pain over epigastrium and upper gastrointestinal endoscopy revealed a small submucosal lesion of 10 mm in the duodenal bulb. The endoscopic ultrasound showed the lesion arising from the echo layer three. The biopsy was taken which showed the duodenal NET. The computed tomography of abdomen did not show any evidence of distant metastasis. The EMR of duodenal NET was done by band ligation technique. The biopsy from the resected duodenal lesion confirmed the duodenal NET with the margin free of the tumor. The patient was followed at 6, 12, 18 and 24 months. During the follow up visits, the repeat upper gastrointestinal endoscopy did not show recurrence of the lesion and there was no any evidence of distant metastasis either. Ligation assisted EMR is an acceptable treatment in the hands of expert for small duodenal NET without the evidence of metastasis and can ensure the complete removal of the lesion with vertical free margin.

Highlights

Duodenal neuroendocrine tumor (NET) is a rare solitary lesion arising from the mucosa and submucosa of the duodenum, which is found incidentally during upper gastrointestinal endoscopy
Recent study done in 10 patients showed that if the duodenal NET is located in the submucosal layer, is less than 13 mm in diameter, and is free of metastasis, ligation assisted Eendoscopic Mucosal Resection (EMR) can successfully remove duodenal NET with a negative vertical margin.[5]
Case Description In our study, we present a patient of 51-year-old male, who presented with pain over epigastrium and upper gastrointestinal endoscopy revealed a small submucosal lesion of 10 mm with a broad base in the duodenal bulb

Summary

Introduction

Duodenal neuroendocrine tumor (NET) is a rare solitary lesion arising from the mucosa and submucosa of the duodenum, which is found incidentally during upper gastrointestinal endoscopy. It was seen that the higher complete resection rate for rectal or esophageal submucosa tumors was achieved with ligation-assisted EMR than conventional EMR.[3,4] The EMR procedure itself is simple, safe, and time-saving, but EMR done to resect duodenal NETs is likely to have positive vertical margins.[5] The Endoscopic Submucosal Dissection (ESD) may yield a higher. Recent study done in 10 patients showed that if the duodenal NET is located in the submucosal layer, is less than 13 mm in diameter, and is free of metastasis, ligation assisted EMR can successfully remove duodenal NET with a negative vertical margin.[5]. During the follow up visits, the repeat upper gastrointestinal endoscopy did not show recurrence of the lesion and there was no any evidence of distant metastasis either

Discussion

Conclusion