Endoscopic resection with one-port placement for duodenal neuroendocrine tumor: toward more minimally invasive endoscopic management

Endoscopic resection with one-port placement (EROPP) was initially reported as a hybrid endoscopic full-thickness resection procedure, offering a safe and minimally invasive treatment option for gastric gastrointestinal stromal tumors [1]. A key advantage of EROPP is its ability to maintain constant intra-abdominal pressure and ensure a clear visual field during endoscopy [1]. This report presents the first use of EROPP in treating a small duodenal neuroendocrine tumor (NET) in a patient for whom major surgery was high risk.

A 75-year-old man with a medical history of diabetes mellitus and surgical treatment for colorectal cancer and lung cancer was referred for management of a 10-mm NET at the duodenal bulb ([Fig. 1]). Given the patient’s advanced age, comorbidities, and previous extensive surgical history, EROPP was selected as the treatment modality. The procedure was performed using a single laparoscopic port inserted into the left abdominal region before the endoscopic procedure ([Fig. 2] a, [Video 1]).

Fig. 1 A 10-mm neuroendocrine tumor with submucosal invasion at the duodenal bulb. a White-light imaging. b Narrow-band imaging. c Chromoendoscopy with indigo carmine. d Endoscopic ultrasonography.

Fig. 2 Endoscopic resection with one-port placement. a A single laparoscopic port inserted into the left abdominal region. b Complete full-thickness resection using a Clutch Cutter (Fujifilm Co., Tokyo, Japan). c Incomplete closure of the defect after using an over-the-scope clip. d Complete closure of the defect using an over-the-scope clip with reopenable clip-over-the-line method.

Endoscopic full-thickness resection with one-port placement for a duodenal neuroendocrine tumor.Video 1

The endoscopic procedure was performed, starting with marking around the lesion and submucosal injection into the submucosal layer, followed by circumferential incision using a 3.5-mm Clutch Cutter (Fujifilm Co., Tokyo, Japan) under gel immersion. The submucosal fibers were trimmed exposing the muscle layer, and dental floss and clip traction were applied. Then, the gel was removed to prevent exposing the peritoneum to the gel. Complete full-thickness resection and specimen retrieval perorally were accomplished in 25 minutes ([Fig. 2] b). Closure of the duodenal defect was then attempted using a 9-mm over-the-scope (OTS) clip. Unfortunately, the OTS clip failed to close the defect completely, and fluid leakage was detected from the laparoscopic port ([Fig. 2] c). Complete defect closure was achieved using the reopenable clip-over-the-line method ([Fig. 2] d) [2].

The patient was discharged on the 4th day after the procedure with an uneventful recovery. Histopathological diagnosis was a NET G1 with negative horizontal and vertical margins but positive for lymphovascular invasion.

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Conflict of Interest

The authors declare that they have no conflict of interest.

• References

• 1 Sawada A, Hirasawa K, Sato C. et al. Endoscopic resection with one-port placement: a newly developed technique for the safe management of advanced endoscopic resection for gastric gastrointestinal stromal tumors. Digestion 2023; 104: 460-467
• 2 Nomura T, Sugimoto S, Temma T. et al. Reopenable clip-over-the-line method for closing large mucosal defects following colorectal endoscopic submucosal dissection: a feasibility study. Endosc Int Open 2023; 11: E697-E702

Publication History

Article published online:
05 February 2025