Post written by Shou-jiang Tang, MD, from the Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi.

The author reports a 56-year-old woman with an 11-mm biopsy-proven duodenal bulb low-grade neuroendocrine tumor (NET) or carcinoid tumor. She was referred by surgery for endoscopic ablation. Using a multi-band ligator device (Saeed 6-Shooter) and a single endoclip (Instinct clip, Cook Medical), clip band ligation ablation (C-BLA) was performed in less than 1 minute, and she did not experience any symptoms after the procedure. During follow-up endoscopy 1 month later, only a post-ablation scar and a 2-mm erosion was seen at the ablation site. Extensive biopsy of the erosion and scar, including stacked biopsy to obtain submucosal tissue, was performed. Pathology showed no evidence of residual NET cells.

Band ligation-assisted endoscopic mucosal resection (BL-EMR) is an established procedure to remove esophageal, gastric, rectal mucosal, and submucosal lesions. Not infrequently, small duodenal carcinoids or NETs are found during routine endoscopy. These tumors are located in the submucosal and mucosal layers. Although there are reports of managing small duodenal NETs with BL-EMR, there are risks of perforation. The author had experienced 2 cases of immediate perforation after performing BL-EMR for small duodenal NETs. One of these patients needed surgical repair of the perforation, and the other one was managed by endoclip closure of the perforation.

The author proposes that C-BLA therapy can be considered in the management of small bowel and colon submucosal lesions that need to be removed, including neoplasms and bleeding vascular lesions.

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