Non-ampullary duodenal neuroendocrine tumours - a tertiary referral centre experience

Duodenal neuroendocrine tumours (duodenal NETs) are uncommon tumours, accounting for 3% of all duodenal malignancies. They can have varied clinical behaviour and often can have metastatic disease at presentation. Due to the unpredictable clinical behaviour, European Neuroendocrine Tumour Society guidelines recommend the consideration of resection of these lesions if the disease is localised. Endoscopic resection is challenging in the duodenum due to the thin mucosal wall and difficulty with access depending on the location of the lesion. We reviewed our experience of 42 non-ampullary duodenal NETs managed at a single centre. 81% had resection for the duodenal NETs of which 50% were resected endoscopically. Endoscopic outcomes were excellent with macroscopic resection of all lesions, there was 1 perforation and no 30-day mortality. Of cases considered for surgery, 38% had nodal involvement and some metastatic disease. Lesions of grade 2 and those larger than 15 mm in size had a high risk of nodal involvement. A careful selection of cases with accurate staging using EUS, PET imaging and careful lesion assessment enables high success rates for endoscopic resection.