Endoscopic Resection of Duodenal Neuroendocrine Tumors in a Western Cohort

BACKGROUND: The incidence of duodenal neuroendocrine tumors (D-NETs) has been steadily rising. Endoscopic resection has become the preferred treatment option for smaller, localized lesions. We aimed to corroborate the efficacy and safety of endoscopic resection of D-NETs in a Western population and to evaluate treatment durability and disease course by examining long-term outcomes after resection. METHODS: This was a retrospective cohort study of patients who underwent endoscopic resection of a nonampullary D-NET from 2012 through 2020 at a single institution in the United States. Demographic, clinical, and procedural data were abstracted in duplicate and independent fashion. Outcomes were assessed through medical records review and follow-up phone calls. RESULTS: Over the study period, 58 patients underwent endoscopic resection of 59 D-NETs. Follow-up data were available in 85% of patients with a median follow-up duration of 23 months. Almost all D-NETs were located in the duodenal bulb, and all were biologically indolent. The mean size 6.6 mm (range: 1 to 27 mm). The most common resection technique was cap- or band-assisted endoscopic mucosal resection (73%). Negative resection margins were achieved in 78% of the sample. Delayed hemorrhage and perforation occurred in 5 and 6 patients, respectively; all but one were managed endoscopically. The presence of residual or recurrent neoplasm was identified at follow-up endoscopy in 10 patients and did not appear to be associated with resection margin status or endoscopic removal technique. No patients required surgical resection of a NET, were diagnosed with metastatic NET, or died as the result of their neuroendocrine tumor during follow-up. CONCLUSION: Endoscopic resection appears to be reasonably safe and durably effective in treating localized duodenal neuroendocrine tumors, but attention to endoscopic rescue of adverse events and to follow-up is necessary.