Endoscopic submucosal dissection of a large duodenal neuroendocrine tumor adjacent to the pyloric ring

摘要

Endoscopic submucosal dissection (ESD) in the duo-denum is technically difficult because of the thinnerduodenal wall and poor maneuverability of the endoscoperesulting from the sharp angulation of the duodenum. 1Although well-differentiated nonfunctional duodenal neuro-endocrine tumors (NETs) that are limited to the mucosa/submucosa, ?10 mm, can be endoscopically removed, theoptimal management of duodenal NETs 10 to 19 mm is stillcontroversial. Published studies have reported the utility ofESD for removal of duodenal NETs measuring ?10 mm indiameter. Reports on treatment with ESD for tumors>10 mm in size are very limited. 2-5 Here, we report thecase of a large submucosal lesion in the duodenal bulb thatwas adjacent to the pyloric ring. The saline solution immer-sion technique and a short-type small caliber-tip transparenthood cap were used, which helped us to successfully exposethe narrow submucosal space and open the cutting edge ofthe mucosa (Video 1 available online at www.VideoGIE.org).