A case of Endoscopic Submucosal Dissection for a carcinoid tumor of the duodenum

Abstract

The standard treatment for duodenal carcinoid has been surgical resection. This report describes the possibility of endoscopic treatment as an alternative treatment for duodenal carcinoid. The patient was 78 year-old man with partial paralysis. Submucosal tumor in the bulb of duodenum was found during follow-up endoscopic examination after endoscopic mucosal resection of gastric hyperplastic polyp. Biopsy specimens revealed a carcinoid tumor. He had no symptom. Biochemical value and endocrine functions were normal. Computed Tomography did not detect any evident lymph node metastasis and endoscopic ultrasound showed a homogeneously low echoic mass located at the submucosal layer. We suggested surgical resection but he refused. Endoscopic mucosal resection was difficult because carcinoid was close to pylorus. So we performed endoscopic submucosal dissection in our hospital. Histological examination of the resected specimen revealed that horizontal margin were negative and there was no vascular infiltration. Although vertical margin were positive, there has not been the evidence of tumor recurrence after two years. Small carcinoid often has lymph node metastasis so surgical resections are ideal but some cases are inoperable. Our experience in this case shows the possibility of endoscopic submucosal dissection as an alternative treatment.