Journal of Clinical Gastroenterology. 49(4):289–292, APRIL 2015
DOI: 10.1097/MCG.0000000000000085
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PMID: 24518797
Issn Print: 0192-0790
Publication Date: April 2015
Small Duodenal Carcinoids: A Case Series Comparing Endoscopic Resection and Autoamputation With Band Ligation
John Scherer;Julie Holinga;Michael Sanders;Jennifer Chennat;Asif Khalid;Kenneth Fasanella;Aatur Singhi;Kevin McGrath;
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Departments of *Medicine†Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
Abstract
We sought to compare the efficacy and safety of endoscopic ultrasound–guided endoscopic resection (ER) and endoscopic band ligation (EBL) for autoamputation of small duodenal carcinoids.The ideal management of small duodenal carcinoid tumors remains unclear.A retrospective review of duodenal carcinoids over a 10-year period (2002 to 2012) was performed at our tertiary-care teaching hospital. All patients with duodenal carcinoids ≤10 mm in size treated with either ER or EBL were included. The main outcome measurements were the efficacy and safety of endotherapy.A total of 37 patients with 39 subcentimeter duodenal carcinoids were identified. In the EBL group, the mean (SD) tumor size was 6.7±2.1 mm compared with 6.7±1.7 mm in the ER group (P=0.943). The mean Ki-67 index was ≤2% in specimens available for histologic analysis in both groups (16/23 EBL and 15/16 ER). The positive deep margin rate in the ER group was 68.8%. Residual carcinoid tumor cells were detected on follow-up biopsies in 1 patient after EBL, and 2 patients after ER. All underwent subsequent successful endotherapy. No adverse events occurred in the EBL group compared with an 18.8% adverse event rate in the ER group (P=0.066).Endoscopic ultrasound–guided EBL is a safe, effective method for removal of small superficial duodenal carcinoids and seems to be a lower risk alternative to conventional ER with cautery.
