title: Endoscopic resection of duodenal bulb neuroendocrine tumor larger than 10 mm in diameter.
abstract: BACKGROUND
  Endoscopic treatment for duodenal bulb neuroendocrine tumor larger than 10 mm is still controversial. This report presents four cases successfully treated with endosonography (EUS)-assisted endoscopic mucosal resection (EMR) procedure for duodenal bulb neuroendocrine tumor larger than 10 mm in diameter.
  
  
  METHODS
  The case series of four patients diagnosed with neuroendocrine tumor from 2003 to 2008 were reviewed. EUS demonstrated well-defined hypoechoic tumors confined to the submucosal hyperechoic layer and the underlying hypoechoic muscularis propria was intact in all four patients. EMR were planned and performed for the duodenal bulb neuroendocrine tumors larger than 10 mm.
  
  
  RESULTS
  En bloc resections with tumor free lateral and basal margins were accomplished using an endoscopic diathermic snare with forward-viewing instruments without any complications. Neither residual duodenal neuroendocrine tumors nor metastatic lesions were detected during the observation period ranging 19 to 78 months
  
  
  CONCLUSIONS
  Duodenal bulb neuroendocrine, larger than 10 mm in diameter, can be treated by endoscopic procedure, after confirming that the tumor confined to the submucosal layer in EUS examination, and no lymph node involvement by abdominal CT and US.
authors.affiliation: Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan.
authors.forename: Shozo
authors.initials: S
authors.lastname: Yokoyama
authors.forename: Katsunari
authors.initials: K
authors.lastname: Takifuji
authors.forename: Masaji
authors.initials: M
authors.lastname: Tani
authors.forename: Manabu
authors.initials: M
authors.lastname: Kawai
authors.forename: Teiji
authors.initials: T
authors.lastname: Naka
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Uchiyama
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yamaue
mesh_terms: D004379:Duodenal Neoplasms / Q000473:pathology / Q000601:surgery*; D004384:Duodenoscopy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D018358:Neuroendocrine Tumors / Q000473:pathology / Q000601:surgery*; D047368:Tumor Burden; D018084:Ultrasonography, Interventional