The role of endoscopic submucosal dissection in the treatment of large superficial duodenal epithelial neoplasia
Abstract
Background and Aims: Endoscopic submucosal dissection is one of the recommended treatment modality in terms of facilitating en-bloc resection in patients with superficial duodenal epithelial neoplasm larger than 2 cm. There is limited information in the literature about the applicability of endoscopic submucosal dissection in superficial duodenal epithelial neoplasm. In this single-center study, the results of eight patients with superficial duodenal epithelial neoplasm who underwent endoscopic submucosal dissection were retrospectively analyzed. Materials and Methods: Twelve patients who underwent duodenal endoscopic submucosal dissection between February 2019 and November 2023 were screened. Eight patients with superficial duodenal epithelial neoplasm larger than 2 cm were included in the study. Results: The median tumor diameter was 27.5 mm (20 - 80 mm). The most common localization was the duodenum second part (87.5%). En bloc and R0 resection rates were each 100%. The median procedure time was 37.5 min. Two patients (20%) with complications were treated with endoscopic clips. No recurrence was observed in all patients (mean 21 months). Conclusion: Endoscopic submucosal dissection is a technically challenging but successful method in the treatment of superficial duodenal epithelial neoplasm. Due to the high risk of complications, duodenal endoscopic submucosal dissection should be performed in experienced centers.
References
- 1. Jepsen JM, Persson M, Jakobsen NO, et al. Prospective study of prevalence and endoscopic and histopathologic characteristics of duodenal polyps in patients submitted to upper endoscopy. Scand J Gastroenterol. 1994;29(6):483-7.
- 2. Kinoshita S, Nishizawa T, Ochiai Y, et al. Accuracy of biopsy for the preoperative diagnosis of superficial nonampullary duodenal adenocarcinoma. Gastrointest Endosc. 2017;86(2):329-32.
- 3. Vanbiervliet G, Moss A, Arvanitakis M, et al. Endoscopic management of superficial nonampullary duodenal tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2021;53(5):522-34.
- 4. Binmoeller KF, Shah JN, Bhat YM, Kane SD. "Underwater" EMR of sporadic laterally spreading nonampullary duodenal adenomas (with video). Gastrointest Endosc. 2013;78(3):496-502.
- 5. Kanaji S, Morita Y, Yamazaki Y, et al. Feasibility of laparoscopic endoscopic cooperative surgery for non-ampullary superficial duodenal neoplasms: Single-arm confirmatory trial. Dig Endosc. 2021;33(3):373-80.
- 6. Kato M, Takeuchi Y, Hoteya S, et al. Outcomes of endoscopic resection for superficial duodenal tumors: 10 years' experience in 18 Japanese high volume centers. Endoscopy. 2022;54(7):663-70.
- 7. Yahagi N, Kato M, Ochiai Y, et al. Outcomes of endoscopic resection for superficial duodenal epithelial neoplasia. Gastrointest Endosc. 2018;88(4):676-82.
- 8. Ochiai Y, Kato M, Kiguchi Y, et al. Current Status and Challenges of Endoscopic Treatments for Duodenal Tumors. Digestion. 2019;99(1):21-6.
- 9. Krenzer A, Heil S, Fitting D, et al. Automated classification of polyps using deep learning architectures and few-shot learning. BMC Med Imaging 2023;23(1):59.
- 10. Ngamruengphong S, Aihara H, Friedland S, et al. Endoscopic submucosal dissection for colorectal dysplasia in inflammatory bowel disease: a US multicenter study. Endosc Int Open. 2022;10(4):E354-60.
- 11. Matsui H, Tamai N, Futakuchi T, et al. Multi-loop traction device facilitates gastric endoscopic submucosal dissection: ex vivo pilot study and an inaugural clinical experience. BMC Gastroenterol. 2022;22(1):10.
- 12. Ikenoyama Y, Yoshimizu S, Namikawa K, et al. Sporadic non-ampullary duodenal adenoma with low-grade dysplasia: Natural history and clinical management. Endosc Int Open. 2022;10(3):E254-61.
- 13. Esaki M, Haraguchi K, Akahoshi K, et al. Endoscopic mucosal resection vs endoscopic submucosal dissection for superficial non-ampullary duodenal tumors. World J Gastrointest Oncol. 2020;12(8):918-30.
- 14. Pérez-Cuadrado-Robles E, Quénéhervé L, et al. ESD versus EMR in non-ampullary superficial duodenal tumors: a systematic review and meta-analysis. Endosc Int Open. 2018;6(8):E998-E1007.
- 15. Kato M, Sasaki M, Mizutani M, et al. Predictors of technical difficulty with duodenal ESD. Endosc Int Open. 2019;7(12):E1755-60.
- 16. Otowa Y, Kanaji S, Morita Y, et al. Safe management of laparoscopic endoscopic cooperative surgery for superficial non-ampullary duodenal epithelial tumors. Endosc Int Open. 2017;5(11):E1153-8.
- 17. Nakayama A, Kato M, Takatori Y, et al. How I do it: Endoscopic diagnosis for superficial non-ampullary duodenal epithelial tumors. Dig Endosc. 2020;32(3):417-24.
- 18. Fukuhara S, Kato M, Iwasaki E, et al. External drainage of bile and pancreatic juice after endoscopic submucosal dissection for duodenal neoplasm: Feasibility study (with video). Dig Endosc. 2021;33(6):977-84.
Abstract
Giriş ve Amaç: Endoskopik submukozal diseksiyon, 2 cm'den büyük yüzeyel duodenal epitelyal neoplazmı olan hastalarda en-blok rezeksiyonun kolaylaştırılması açısından önerilen tedavi yöntemlerinden biridir. Literatürde endoskopik submukozal diseksiyonun yüzeyel duodenal epitelyal neoplazmda uygulanabilirliği hakkında sınırlı bilgi bulunmaktadır. Bu çalışmada endoskopik submukozal diseksiyon uygulanan sekiz yüzeyel duodenal epitelyal neoplasm hastasının sonuçları retrospektif olarak analiz edildi. Gereç ve Yöntem: Şubat 2019 ile Kasım 2023 tarihleri arasında duodenal endoskopik submukozal diseksiyon uygulanan 12 hasta tarandı. Yüzeyel duodenal epitelyal neoplazmi 2 cm'den büyük olan 8 hasta çalışmaya dahil edildi. Bulgular: Medyan tümör çapı 27.5 mm (20 - 80 mm) idi. En sık lokalizasyon duodenumun ikinci kısmıydı (%87.5). En blok ve R0 rezeksiyon oranlarının her biri %100 idi. Ortalama işlem süresi 37.5 dakika idi. Komplikasyon gelişen iki hasta (%20) endoskopik kliplerle tedavi edildi. Hastaların tamamında (ortalama 21 ay) nüks görülmedi. Sonuç: Endoskopik submukozal diseksiyon, yüzeyel duodenal epitelyal neoplazm tedavisinde teknik açıdan zor ancak başarılı bir yöntemdir. Komplikasyon riskinin yüksek olması nedeniyle duodenal endoskopik submukozal diseksiyon deneyimli merkezlerde yapılmalıdır.
References
- 1. Jepsen JM, Persson M, Jakobsen NO, et al. Prospective study of prevalence and endoscopic and histopathologic characteristics of duodenal polyps in patients submitted to upper endoscopy. Scand J Gastroenterol. 1994;29(6):483-7.
- 2. Kinoshita S, Nishizawa T, Ochiai Y, et al. Accuracy of biopsy for the preoperative diagnosis of superficial nonampullary duodenal adenocarcinoma. Gastrointest Endosc. 2017;86(2):329-32.
- 3. Vanbiervliet G, Moss A, Arvanitakis M, et al. Endoscopic management of superficial nonampullary duodenal tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2021;53(5):522-34.
- 4. Binmoeller KF, Shah JN, Bhat YM, Kane SD. "Underwater" EMR of sporadic laterally spreading nonampullary duodenal adenomas (with video). Gastrointest Endosc. 2013;78(3):496-502.
- 5. Kanaji S, Morita Y, Yamazaki Y, et al. Feasibility of laparoscopic endoscopic cooperative surgery for non-ampullary superficial duodenal neoplasms: Single-arm confirmatory trial. Dig Endosc. 2021;33(3):373-80.
- 6. Kato M, Takeuchi Y, Hoteya S, et al. Outcomes of endoscopic resection for superficial duodenal tumors: 10 years' experience in 18 Japanese high volume centers. Endoscopy. 2022;54(7):663-70.
- 7. Yahagi N, Kato M, Ochiai Y, et al. Outcomes of endoscopic resection for superficial duodenal epithelial neoplasia. Gastrointest Endosc. 2018;88(4):676-82.
- 8. Ochiai Y, Kato M, Kiguchi Y, et al. Current Status and Challenges of Endoscopic Treatments for Duodenal Tumors. Digestion. 2019;99(1):21-6.
- 9. Krenzer A, Heil S, Fitting D, et al. Automated classification of polyps using deep learning architectures and few-shot learning. BMC Med Imaging 2023;23(1):59.
- 10. Ngamruengphong S, Aihara H, Friedland S, et al. Endoscopic submucosal dissection for colorectal dysplasia in inflammatory bowel disease: a US multicenter study. Endosc Int Open. 2022;10(4):E354-60.
- 11. Matsui H, Tamai N, Futakuchi T, et al. Multi-loop traction device facilitates gastric endoscopic submucosal dissection: ex vivo pilot study and an inaugural clinical experience. BMC Gastroenterol. 2022;22(1):10.
- 12. Ikenoyama Y, Yoshimizu S, Namikawa K, et al. Sporadic non-ampullary duodenal adenoma with low-grade dysplasia: Natural history and clinical management. Endosc Int Open. 2022;10(3):E254-61.
- 13. Esaki M, Haraguchi K, Akahoshi K, et al. Endoscopic mucosal resection vs endoscopic submucosal dissection for superficial non-ampullary duodenal tumors. World J Gastrointest Oncol. 2020;12(8):918-30.
- 14. Pérez-Cuadrado-Robles E, Quénéhervé L, et al. ESD versus EMR in non-ampullary superficial duodenal tumors: a systematic review and meta-analysis. Endosc Int Open. 2018;6(8):E998-E1007.
- 15. Kato M, Sasaki M, Mizutani M, et al. Predictors of technical difficulty with duodenal ESD. Endosc Int Open. 2019;7(12):E1755-60.
- 16. Otowa Y, Kanaji S, Morita Y, et al. Safe management of laparoscopic endoscopic cooperative surgery for superficial non-ampullary duodenal epithelial tumors. Endosc Int Open. 2017;5(11):E1153-8.
- 17. Nakayama A, Kato M, Takatori Y, et al. How I do it: Endoscopic diagnosis for superficial non-ampullary duodenal epithelial tumors. Dig Endosc. 2020;32(3):417-24.
- 18. Fukuhara S, Kato M, Iwasaki E, et al. External drainage of bile and pancreatic juice after endoscopic submucosal dissection for duodenal neoplasm: Feasibility study (with video). Dig Endosc. 2021;33(6):977-84.
Details
| Primary Language | English |
|---|---|
| Subjects | Gastroenterology and Hepatology |
| Journal Section | Articles |
| Authors | |
| Publication Date | April 25, 2024 |
| Submission Date | February 14, 2024 |
| Acceptance Date | March 18, 2024 |
| Published in Issue | Year 2024 Volume: 23 Issue: 1 |
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