title: Small duodenal carcinoids: a case series comparing endoscopic resection and autoamputation with band ligation.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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±2.1 mm compared with 6.7±1.7 mm 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.
authors: Departments of *Medicine †Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors: John R
authors: JR
authors: Scherer
authors: Julie
authors: J
authors: Holinga
authors: Michael
authors: M
authors: Sanders
authors: Jennifer
authors: J
authors: Chennat
authors: Asif
authors: A
authors: Khalid
authors: Kenneth
authors: K
authors: Fasanella
authors: Aatur D
authors: AD
authors: Singhi
authors: Kevin
authors: K
authors: McGrath
mesh_terms: D000328:Adult; D000368:Aged; D002276:Carcinoid Tumor / Q000473:pathology / Q000601:surgery*; D004384:Duodenoscopy / Q000379:methods*; D004386:Duodenum; D005260:Female; D006801:Humans; D007414:Intestinal Neoplasms / Q000473:pathology / Q000601:surgery*; D008026:Ligation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional