Laparoscopic wedge resection of a descending duodenal gastrointestinal stromal tumor under endoscopic nasobiliary drainage guidance: A case report.

Introduction: Gastrointestinal stromal tumors (GIST), which occur anywhere in the gastrointestinal (GI) tract, typically occur in the stomach and small intestine but rarely in the duodenum. We present a case report wherein a descending duodenal GIST was treated with a limited, minimally invasive surgery after endoscopic nasobiliary drainage (ENBD) insertion.

Presentation of case: A 67-year-old woman visited our hospital with an incidentally discovered duodenal tumor. Gastroduodenoscopy revealed a duodenal subepithelial tumor (SET) measuring approximately 2 cm in descending duodenum. Endoscopic ultrasound revealed a well-circumscribed, inhomogeneous hypoechoic lesion measuring approximately 17 × 4.6 mm, thought to arise from the muscularis layer. Computed tomography (CT) revealed an inhomogeneous enhancing mass with central necrosis, measuring approximately 2.7 cm, in the descending duodenum. Pathological findings from the bite-on-bite biopsy showed c-kit and DOG-1 positivity and CD34 and desmin negativity, leading to a GIST diagnosis. Laparoscopic wedge resection with preoperative ENBD insertion was planned due to the risk of pancreaticobiliary duct (PBD) damage during surgery because the lesion was located near the ampulla of Vater (AoV) and minor papilla. Surgery was performed using laparoscopic wedge resection without PBD injury. The patient was discharged 10 days post-surgery without complications.

Discussion: Descending duodenal GIST is difficult to operate on with minimally invasive surgery. However, if the size is not excessive and the PBD is not involved, minimal and limited surgery is possible after ENBD insertion.

Conclusion: We report the first case of limited and minimally invasive surgery followed by ENBD insertion in a rare descending duodenal GIST.