Duodenal Neuroendocrine Tumour Resection with a New Duodenal Full-Thickness Resection Device

Most well-differentiated, non-functional duodenal neuroendocrine tumours (NETs) limited to the mucosa/ submucosa can be treated effectively with endoscopic resection [1]. A full-thickness resection device (FTRD; Ovesco Endoscopy®) enables endoscopic transmural resection of suitable lesions with a fast minimally invasive technique [2]. A colonic FTRD was used for duodenal lesions as an “off-label” indication with good clinical outcomes and a complication rate comparable to duodenal endoscopic mucosal resection [3]. A duodenal FTRD (dFTRD) with smaller diameter (19.5 vs. 21 mm), balloonassisted insertion and less clip interdental space was developed allowing easier upper oesophageal sphincter passage and minimising bleeding risk. We describe a 74-year-old male with a 10-mm postpyloric bulbar submucosal lesion (Fig. 1, 2) with biopsies showing a well-differentiated NET. Endoscopic ultrasonography showed a submucosal lesion. Endoscopic ultrasonography and 68-Ga DOTA-NOC PET/CT displayed no lymph node involvement or distant metastases. An attempt to resect with band ligation endoscopic mucosal resection failed because of an absence of aspiration into the cap. Transmural resection with the d-FTRD was scheduled in the operating room under general anaesthesia. Lesion borders were marked with argon plasma coagulation. Upper oesophageal sphincter dilation was performed with Savary-Gilliard bougie dilator (15–18 mm) allowing d-FTRD insertion. A paediatric colonoscope (outer diameter: 11.8 mm; working channel calibre: 3.2 mm) was then advanced to the duodenum with the dFTRD attached. Traction of the lesion to the cap with the grasper and slight aspiration were done, followed by overthe-scope clip release (d-FTRD clip). Aspiration was nec-