Small Duodenal Carcinoids A Case Series Comparing Endoscopic Resection and Autoamputation With Band Ligation

Goals: We sought to compare the efficacy and safety of endoscopic ultrasound-guided endoscopic resection (ER) and endoscopic band ligation (EBL) for autoamputation of small duodenal carcinoids. Background: The ideal management of small duodenal carcinoid tumors remains unclear. Study: A retrospective review of duodenal carcinoids over a 10-year period (2002 to 2012) was performed at our tertiary-care teaching hospital. All patients with duodenal carcinoids <10 mm in size treated with either ER or EBL were included. The main outcome measurements were the efficacy and safety of endotherapy. Results: A total of 37 patients with 39 subcentimeter duodenal carcinoids were identified. In the EBL group, the mean (SD) tumor size was 6.7 +/- 2.1mm compared with 6.7 +/- 1.7mm in the ER group (P = 0.943). The mean Ki-67 index was <= 2% in specimens available for histologic analysis in both groups (16/23 EBL and 15/16 ER). The positive deep margin rate in the ER group was 68.8%. Residual carcinoid tumor cells were detected on follow-up biopsies in 1 patient after EBL, and 2 patients after ER. All underwent subsequent successful endotherapy. No adverse events occurred in the EBL group compared with an 18.8% adverse event rate in the ER group (P = 0.066). Conclusions: Endoscopic ultrasound-guided EBL is a safe, effective method for removal of small superficial duodenal carcinoids and seems to be a lower risk alternative to conventional ER with cautery.