Poster 197 Over-the-Scope Clip for Duodenal Carcinoid Excision
Author Insight from Sherif Andrawes, MD, Staten Island University Hospital
What’s new here and important for clinicians?
Duodenal carcinoid is a gastrointestinal tumor found in the small intestine occurring in 0.07 per 100,000 people, per year. The most common location is the small bowel, particularly in the duodenal bulb, which has a thin anatomy of the wall. Current surgical treatment for excision in the duodenum is invasive. Endoscopic resection provides a minimally invasive approach; however, obtaining a margin free of neuroendocrine cells (carcinoid tumor) and removing carcinoid tumors in the deep layers is often a challenge. Using over-the-scope clip (OTSC) allows clinicians to fully trap the carcinoid tumor with the endoscope prior to resection. This will create a safety pad prior to the resection and achieve a resection margin free of disease. The OTSC is mounted on a suction cap that is placed on the tip of the endoscope. The tumor is deeply suctioned into a cap and the clip is deployed to trap the carcinoid tumor within the clip. The clip with the tumor in it remains for 3-4 weeks. This method allows creation of a pad layer of fibrosis underneath the carcinoid, which provides safety for resection and margin free of disease.
What do patients need to know?
Our novel approach allows for the removal of a duodenal carcinoid safely and in an ambulatory setting. It achieves all goals, complete resection, easy technique, safe approach, and resection margins free of neuroendocrine cells (carcinoid tumor). The added benefit of an endoscopic approach is that it is minimally invasive, as opposed to than the traditional surgical approach. In our small series, this approach was effective. A larger series is in progress to examine and validate our findings.
Author Contact Sherif Andrawes, MD, Staten Island University Hospital
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