Transduodenal Local Resection of Ampullary Neuroendocrine Tumors with Bleeding

Abstract

Duodenal neuroendocrine tumors in the Ampulla of Vater occur very rarely and are very difficult to diagnose preoperatively. Duodenal ulcer bleeding due to the destruction of the duodenal mucosa is very rare. In this study, we present the case of a duodenal neuroendocrine tumor presented with upper gastrointestinal bleeding, which was treated by means of transduodenal local resection. As a conclusion, endoscopic or transduodenal local excision is relatively safe to be used in ampullary neuroendocrine tumors with no distant metastasis or local invasions. Endoscopic resection is recommended in patients with low grade tumors within the submucosa, smaller than 2 cm and with a low KI-67 index. In support of this, EUS has been adopted as an important tool to measure the depth of invasion and evaluate the lymph node status in staging the gastrointestinal tumors as well as collecting specimens simultaneously. Finally, endoscopic procedures (ESD - EMR) present a higher risk of perforation, so that a large number of prospective controlled studies are needed to establish a consensus on this therapeutic approach.

Keywords

• transduodenal local resection
• ampullary neuroendocrine tumors
• bleeding