DEFINITIVE ENDOSCOPIC TREATMENT FOR NEUROENDOCRINE DUODENAL TUMOR WITH ENDOSCOPIC SUBMUCOSAL DISSECTION AND FULL-THICKNES RESECTION

70-year-old woman with comorbidity. 15 mm well-differentiated neuroendocrine tumor in the duodenal bulb. The multidisciplinary team meeting decided endoscopic treatment. EMR was attempted, but due to the non-lifting sign, we performed an ESD. Severe fibrosis / infiltration on the muscular layer was found. Traction strategy with clips and rubber band allowed complete en bloc ESD. The vertical margin was positive. The patient was a poor surgical candidate so endoscopic full-thickness resection was planned. The clip was deployed but the preloaded snare broke. A conventional snare was used. No residual tumor was detected. CT scan and scintigraphy were negative at 6 months.