Successful endoscopic resection of large duodenal bulb carcinoid tumor: a case report.

Introduction and importance: The best treatment strategy for intermediate size duodenal neuroendocrine neoplasms (DNETs) measuring "10-20 mm," in terms of effectiveness, feasibility, and simplicity remains a grey area; however, endoscopic resection (ER) is increasingly conducted as an alternative of surgery on a case-by-case basis. Case presentation: We report a rare case of a 43-year-old female patient diagnosed at Almana general hospital, Dammam, Saudi Arabia, with a non-functional non-ampullary duodenal bulb neuroendocrine neoplasm (NAD-NETs) measuring 15 mm, which was discovered incidentally during an upper gastrointestinal endoscopy. Successful endoscopic mucosal resection was done without any local complication. The diagnosis was confirmed through immunohistochemistry. No local recurrence or distant metastasis was detected during early surveillance of the patient. Clinical discussion: Surgery has been the mainstream treatment of NAD-NETs for a long time. However, with continuous progress in endoscopic diagnosis and treatment expertise, the endoscopic treatment of NAD-NETs has gradually gained increasing interest. ER is reported to be effective and safe only for non-functioning duodenal lesions measuring <10 mm. The treatment of DNETs measuring "10-20 mm" remains controversial. ER might be considered only in selected cases and generally for tumors smaller than "15 mm." In view of our case report, ER could be the first treatment option in patients with NAD-NETs measuring "15 mm," without evidence of metastatic disease, and it might be a valid therapeutic alternative to surgical resection. Conclusion: Endoscopic mucosal resection may be a safe, effective, and feasible endoscopic technique for removing NAD-NETs measuring "15 mm" in size and might be a valid therapeutic alternative to invasive surgical resection.