Endoscopy 2019; 51(04): S257
DOI: 10.1055/s-0039-1681947
ESGE Days 2019 ePosters
Friday, April 5, 2019 09:00 – 17:00: Stomach and small intestine ePosters
Georg Thieme Verlag KG Stuttgart · New York

DUODENAL NEUROENDOCRINE TUMOUR RESECTION WITH A NEW DUODENAL FULL THICKNESS RESECTION DEVICE

J Cortez Pinto
1   Instituto Português de Oncologia de Lisboa Francisco Gentil, Gastroenterology, Lisboa, Portugal
,
S Mão de Ferro
1   Instituto Português de Oncologia de Lisboa Francisco Gentil, Gastroenterology, Lisboa, Portugal
,
J Castela
1   Instituto Português de Oncologia de Lisboa Francisco Gentil, Gastroenterology, Lisboa, Portugal
,
I Claro
1   Instituto Português de Oncologia de Lisboa Francisco Gentil, Gastroenterology, Lisboa, Portugal
,
P Chaves
2   Instituto Português de Oncologia de Lisboa Francisco Gentil, Pathology, Lisboa, Portugal
,
A Dias Pereira
1   Instituto Português de Oncologia de Lisboa Francisco Gentil, Gastroenterology, Lisboa, Portugal
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 
 

    Introduction and aims:

    Most well-differentiated, non-functional duodenal NETs limited to the mucosa/submucosa can be treated effectively with endoscopic resection.

    Full thickness resection device (FTRD; Ovesco Endoscopy) enables transmural resection of suitable lesions with a fast minimally invasive technique. Colonic FTRD was used for duodenal lesions as an “of-label” indication with good clinical outcomes and a complications' rate compared to duodenal endoscopic mucosal resection (EMR). A duodenal FTRD (d-FTRD) with smaller diameter (19,5 mm vs. 21 mm), balloon assisted insertion and less clip interdental space was developed allowing easier upper esophageal sphincter (UES) passage and minimising bleeding risk.

    Methods:

    We describe a 74-year-old male with a 10 mm post-pyloric bulbar submucosal lesion with biopsies showing a well-differentiated NET. Endoscopic ultrasonography (EUS) showed a submucosal lesion. EUS and 68-Ga-DOTA-NOC PET/CT displayed no lymph node involvement or distant metastases. An attempt to resect with band ligation EMR failed because of an absence of aspiration into the cap.

    Transmural resection with the d-FTRD was scheduled in the operating room under general anaesthesia. Lesion borders were marked with APC. UES dilation was performed with Savary-Guilliard bougie dilator (15 – 18 mm) allowing d-FTRD insertion.

    A paediatric colonoscope was then advanced to the duodenum with the d-FTRD attached. Traction of the lesion to the cap with the grasper and aspiration was done, followed by over-the-scope clip release (OTSC). The pseudopolype produced by the OTSC was resected with a 15 mm diatermic snare.

    Results:

    There were no immediate or delayed complications. Histology showed a NET G1 (< 3 mitosis/10 high power field, Ki67 < 3%) with infiltration of the muscularis propria. There was no lymphatic or perineural invasion. The lateral margin of the lesion in the pyloric side was coincident to the resection margin.

    Conclusions:

    d-FTRD is a new device that should be considered for the resection of subepithelial or non-lifting epithelial duodenal lesions.


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