Background and Aims: There is no consensus on the optimal treatment of duodenal carcinoid tumors. Endoscopic mucosalresection (EMR) is considered appropriate for tumors <1cm in size confined to the mucosa/submucosa. In this retrospective study we examine the safety and efficacy of duodenal carcinoid EMRat a single tertiary care center. Methods: All patients with duodenal carcinoids resected via EMR at Duke University Medical Center from 1999 to 2012 were identified. All had pathologic diagnoses and endoscopic ultrasound (EUS), followed by EMR using cap-ligation or standard snare polypectomy. Results: 43 duodenal carcinoids were resected in 40 patients. 91% of tumors were located in the bulb. All tumors were limited to the mucosa or submucosa. Mean tumor size was 7.0mm. 28 tumors were removed using cap-ligation and 15 using snare polypectomy. Two post-procedure GI bleeds and two perforations occurred (one managed endoscopically, one managed surgically). 17 (40%) resected tumors had positive margins. 13 cases were lost to follow-up. Of the other 27 patients, 3 went on to surgical resection (all had positive margins at EMR). Mean follow-up time was 28.3 months. Three patients had local recurrence (2/3 had positive margins on initial resection), and three had lymph node metastases (all had positive margins on initial resection). Conclusion: This is the largest single center study of its kind. Endoscopic resection of duodenal carcinoids should be considered prior to surgical resection after EUS evaluation to exclude muscularis propria involvement and lymph node spread. The significance of positive margins requires further study. Careful follow-up is necessary.