Underwater traction-assisted endoscopic submucosal dissection of a neuroendocrine tumor in the duodenal bulb

A 68-year-old man with a 15-mm subepithelial lesion (SEL) on the anteroinferior wall of the duodenal bulb, just distal to the pylorus ([Fig. 1] a) was referred for further management. An endoscopic ultrasound (EUS) was performed, which identified a 15-mm oval-shaped, hypoechoic, submucosal lesion, with a finely inhomogeneous echostructure and peripheral vascular signals. Fine-needle biopsy (FNB) with a 22G Trident needle (Micro-Tech, Nanjing, China) confirmed the diagnosis of a neuroendocrine tumor (NET).