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].