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Endoscopic resection of small duodenal carcinoid tumors with strip biopsy technique
1Department of Internal Medicine, Handa City Hospital, Handa, Aichi, Japan.
Background:
Most cases of duodenal carcinoid have conventionally been treated by surgical resection. The aim of our study was to explore the feasibility of endoscopic resection in small duodenal carcinoids.
Methods:
The study population consisted of seven patients with small duodenal carcinoids. The diagnosis was confirmed by preoperative biopsies. The depth of tumor invasion was evaluated by endosonography.
Results:
The carcinoid was detected by endosonography in all cases. Size ranged ultrasonographically from 1.5 mm to 7 mm. Tumor invasion was confined to the submucosa in all patients. Endoscopic resection was performed with the strip biopsy technique using a two-channel endoscope. In six patients, the specimens were resected without severe complications. Five of them were confirmed histologically to be typical carcinoids. In one patient, carcinoid was not detected histologically in the specimen. In the remaining patient, a perforation occurred. However, the huge ulcer was managed conservatively. Follow-up endoscopy revealed no evidence of recurrent or residual tumor in any patient.
Conclusion:
Small duodenal carcinoids confined to the submucosa can be resected endoscopically and preoperative endosonography is necessary for the determination of endoscopic resectability.