Endoscopic resection of duodenal neuroendocrine tumors: safety and long-term oncologic outcomes

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Background and Aims Duodenal neuroendocrine tumors (dNETs) are rare neoplasms with malignant potential. Endoscopic resection (ER) is increasingly used for selected non-ampullary dNETs; however, concerns remain regarding safety and oncologic significance of positive resection margins. This study aimed to evaluate the safety of ER and oncologic outcomes in patients with non-ampullary dNETs. Methods We retrospectively analyzed patients with non-ampullary dNETs undergoing ER (2012–2023). Staging included endoscopic ultrasound and computed tomography for lesions >10 mm or suspected muscularis invasion. Outcomes included adverse events, histopathology, recurrence, and survival. Results Thirty-eight lesions were included. Most lesions were located in the duodenal bulb (97.3%) and measured ≤10 mm. Endoscopic mucosal resection (EMR) with band ligation was performed in 26 lesions (68.4%), followed by conventional EMR (18.4%), underwater EMR (2.7%), laparoscopic endoscopy cooperative surgery (2.7%), and forceps resection (7.8%). No intraprocedural or delayed adverse events occurred. R0 resection was achieved in 63.1% of lesions, 23.6% were classified as R1 and 13.2% as Rx. Twenty-nine (76.3%) were classified as G1 and nine (23.7%) as G2. During a median follow-up of 60 months (range, 24–156 months), one local recurrence occurred three years after resection and was successfully treated endoscopically, with no recurrence. No patient developed locoregional or distant metastases attributable to the index dNET. Conclusion Endoscopic resection of non-ampullary dNETs was associated with a favorable safety profile and disease control, including in cases with positive or indeterminate resection margins. These findings support endoscopic management as a treatment option for selected dNETs managed in experienced centers.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.