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Almost 50% of sporadic duodenal gastrin-expressing neuroendocrine tumors (NETs), so-called gastrinomas, are associated with Zollinger–Ellison syndrome (ZES). The risk for lymph node metastasis is high (40%–70%), even in tumors smaller than 10mm [1]. We report the endoscopic ultrasound (EUS) diagnosis of a case of sporadic duodenal gastrinoma manifesting with ZES. A 57-year old man presented with chronic diarrhea that had lasted for 6 years. Upper gastrointestinal endoscopy showedmultiple ulcerations of the second part of the duodenum. The patient’s high levels of gastrin and chromogranin A (two and four times the normal values, respectively) and proton pump inhibitor-sensitive diarrhea were suggestive of ZES. The results of computed tomographic enterography and somatostatin receptor scintigraphy were normal. EUS showed a hypoechoic, well-defined, 10-mm submucosal lesionof theduodenal bulb (●" Fig.1), without invasion of the muscularis propria, and two suspicious periduodenal lymphnodes. The lesionwas thenvisualized with a side-viewing scope (●" Video 1), and biopsy confirmed a well-differentiated NET. Surgical resection after endoscopic tagging of the lesionwas proposed. Because of the immediately post-pyloric location of the lesion, tagging with clips was precluded. Under EUS guidance, a curvilinear echoendoscope (GF-UCT140; Fig.1 Endoscopic ultrasound showing a hypoechoic, welldefined, 10-mm submucosal lesion of the duodenal bulb (arrows), without invasion of the muscularis propria, in a 57-year-old man presenting with chronic diarrhea of 6 years’ duration.

Diagnosis and preoperative tagging of duodenal gastrinoma by endoscopic ultrasound