Long-term follow-up after endoscopic forceps biopsies for early stage duodenal carcinoid: case report and review of endoscopic treatments.

tumors that account for 2 % to 13.6 % of all gastrointestinal carcinoids, and no guidelines are available for their treat− ment. Small (< 2 cm) nonperiampullary duodenal carcinoids without submucosal invasion have been termed early stage duodenal carcinoids (esDC) [1]; their clinical course appears favorable and en− doscopic treatment would seem to be a feasible treatment option. We report on a female patient treated for an 8−mm polyp of the duodenal bulb, which was diagnos− ed as a carcinoid after forceps biopsies. At the subsequent check up, the patient was free of disease. At 11 years later, after 12 annual endoscopic examinations and pe− riodic monitoring with abdominal com− puted tomography (CT) scan and octreoti− de scintigraphy, there was a recurrence of the neuroendocrine tumor, present in a biopsy of the duodenal scar. No further signs of carcinoid were found at the examination that followed shortly after− wards and so no further treatment was proposed. At 2 years after the recurrence, the patient is disease−free. Treatment of duodenal carcinoids is a controversial issue; approaches include laser ablation, endoscopic and transduo− denal excision, duodenectomy, and pan− creaticoduodenectomy. The morbidity rate for radical resection with lymphad− enectomy appears unacceptable when weighed against the low risk of recurren− ce of esDC. After a Medline search, we found reports on 31 cases of duodenal carcinoid treated by endoscopic procedures: 24 of these tu− mors were excised with disease−free mar− gins, and seven (tumors smaller than 10 mm) disappeared after forceps biop− sies, and their depth of infiltration could not be determined at histopathology (Ta− ble 1]) [2 ± 5]. These data suggest that complete endoscopic excision with tu− mor−free resection margins is the optimal treatment for nonperiampullary esDC without evidence of submucosal infiltra− tion or lymph node metastases at intralu− minal ultrasonography. The case reported here and some data in the literature sug− gest that for duodenal polyps that are smaller than 10 mm, diagnosed as carci− noids after forceps biopsy, and without residual tumor at the second look, no further treatment is required but yearly endoscopic monitoring is advisable.