Diagnostic endoscopic resection as first-line management for grade 1-2 duodenal neuroendocrine tumors: a retrospective study.

Objectives: Duodenal neuroendocrine tumors are increasingly identified incidentally during screening endoscopy. While surgical resection is standard, the role of endoscopic resection, particularly for grade 1 and 2 tumors, remains under discussion. This study aimed to evaluate the feasibility and outcomes of diagnostic endoscopic resection in grade 1 or 2 duodenal neuroendocrine tumors.

Methods: We retrospectively reviewed 40 patients with grade 1 or 2 duodenal neuroendocrine tumors treated at a single tertiary center between November 2008 and July 2023. Clinical, endoscopic, and histopathologic features were analyzed, including resection methods, complications, and long-term outcomes.

Results: The mean tumor size was 7.4 ± 0.9 mm, with 80% of tumors <10 mm. Grade 1 tumors accounted for 90% of the cases. Endoscopic resection was performed in 28 patients; ligation-assisted endoscopic mucosal resection achieved a 100% complete (R0) resection rate. One patient had a perforation, which was successfully managed endoscopically. Five patients did not undergo resection following forceps biopsy. Two patients required additional surgery after endoscopic resection, and 7 underwent primary surgery. No patient exhibited lymph node or distant metastasis, and no recurrence was observed during a mean follow-up period of 59.0 ± 6.9 months.

Conclusions: Endoscopic resection may be a safe and effective first-line treatment for grade 1 or 2 duodenal neuroendocrine tumors, including selected lesions >10 mm. Ligation-assisted endoscopic mucosal resection may be preferred for subcentimeter lesions. Diagnostic endoscopic resection should be considered in selected patients to avoid unnecessary surgery.