P3227 - Deep Submucosal Resection of Duodenal Neuroendocrine Tumors Using Over-the-Scope Clip - A Prospective Single Center Study

Award: Presidential Poster Award

Madhura Prasad, MBBS, MD, MRCP, DNB, Mohan Prasad VG, MD, DM, FACG, Vamsi Murthy K, MBBS, MD, DM, Mithra Prasad, MD, DM, Sunil Verghese, MD, DM, Srinivas Reddy, MD, DM, Debapratim Routh, MD, DM
VGM Hospital, Coimbatore, Tamil Nadu, India

Introduction:

Duodenal neuroendocrine tumors (DNETS) have been increasingly detected incidentally on endoscopy. Moderate sized localized DNETs can be resected endoscopically. While increasing the rate of R0 resection, it is important to prevent perforation in the thin duodenal wall. In this study, endoscopic resection after over-the-scope clip (OTSC) has been used to resect DNETs.

Case Description/Methods:

This study was a prospective single center trial conducted at a tertiary referral hospital in South India. The study protocol was approved by the Institutional Ethics Committee. All patients with localized moderate sized duodenal neuroendocrine tumors who were biopsy proven and amenable for endoscopic resection were included. Imaging such as DOTATATE was done to exclude metastasis. EUS was done to ensure that muscularis propria was not involved and to look for lymph nodal involvement. Those who were unfit for anesthesia were excluded. Informed consent was taken from all the study participants. OTSC used in this study was OVESCO (Tubingen, Germany). 12 mm or 14 mm t type OTSC was mounted on forward viewing or therapeutic scope respectively.The patient data, adverse events, R0 resection, depth of resection, endoscopy findings at six month follow-up was recorded systematically.

Discussion:

Thirteen patients were included. Two patients were excluded when EUS showed tumor extending beyond muscularis propria. Median size of tumor 1.4 cm (7mm to 1.5 cm). There was no immediate or delayed bleeding in any of the patients. There was transient throat pain in 7 patients. The R0 resection rate was 90.9% (10/11). The vertical margin showed involvement in one patient. Regarding the extent of resection, all had deep submucosal resection (100%). None of the tumors had full thickness resection. Ki67 index was < 1% in 10 and 2.5% in one patient. All were grade I. All were synaptophysin and Chromogranin A positive. The median follow-up was 23 months (6-31 months). On follow-up endoscopy at six months, clips were noted in place in 90.9% (10 out of 11) patients. There was no recurrence in any patients. There was tissue in-growth within the clip. Biopsies taken from the in-growth showed no evidence of tumor recurrence.  

Localized moderate sized DNETs, not involving muscularis propria, can be safely resected endoscopically after over-the-scope clip deployment. Larger studies are necessary to confirm this.

 

Disclosures:


Madhura Prasad, MBBS, MD, MRCP, DNB, Mohan Prasad VG, MD, DM, FACG, Vamsi Murthy K, MBBS, MD, DM, Mithra Prasad, MD, DM, Sunil Verghese, MD, DM, Srinivas Reddy, MD, DM, Debapratim Routh, MD, DM. P3227 - Deep Submucosal Resection of Duodenal Neuroendocrine Tumors Using Over-the-Scope Clip - A Prospective Single Center Study, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.