Duodenal neuroendocrine tumor successfully removed by endoscopic submucosal dissection with adaptative traction device

Duodenal neuroendocrine tumors (D-NETs) are uncommon neoplastic entities 1. The current guidelines advocate for resection when the lesion is ≤20 mm in size, in the absence of lymph node involvement 2. However, the utility of endoscopic resection remains unclear, especially due to the risk of incomplete resection 3. Endoscopic submucosal dissection (ESD) is an attractive technique because it offers the potential to achieve en bloc resection with clear margins. In a previous retrospective study, ESD for D-NETs achieved a 100% en bloc resection rate; however, the R0 resection rate is far from perfect and the perforation rate is not null 4. The use of a traction device, with double clips and rubber band traction, has been described previously to improve the exposure of the tiny submucosal space 5.