Endocrine Abstracts

Duodenal neuroendocrine neoplasms (d-NENs) account for approximately 2% of all NENs, frequently encountered incidentally at endoscopy. They can be classified in a number of ways: ampullary/peri-ampullary and non-ampullary; gastrinomas, somatostatinomas, non-functional d-NENs, duodenal gangliocytic paragangliomas and high-grade poorly differentiated NECs. More than 90% arise in the 2st or 2nd part of the duodenum. ENETS guidelines suggest managing d-NENs according to size, with endoscopic resection of those less than 1 cm in diameter (if not peri-ampullary). Endoscopic Submuocsal Dissection generally achieves higher rate of radical resection than Endoscopic Mucosal Resection. d-NENs greater than 2 cm should undergo surgical resection especially if lymph node positive. d-NENs between 1 and 2 cm can be endoscopic or surgically resected. Those with metastatic disease can be managed similarly to metastatic disease in other areas, dependent on grade. However, the natural history of incidental d-NENs is unclear a lack of data in the literature, meaning some cases could be managed by observation/surveillance depending on individual patient factors.