Current Treatment Strategy for Superficial Nonampullary Duodenal Epithelial Tumors

Abstract

Endoscopic submucosal dissection (ESD) is the standard treatment method for esophageal, gastric, and colorectal cancers. However, it has not been standardized for duodenal lesions because of its high complication rates. Recently, minimally invasive and simple methods such as cold snare polypectomy and underwater endoscopic mucosal resection have been utilized more for superficial nonampullary duodenal epithelial tumors (SNADETs). Although the rate of complications associated with duodenal ESD has been gradually decreasing because of technical advancements, performing ESD for all SNADETs is unnecessary. As such, the appropriate treatment plan for SNADETs should be chosen according to the lesion type, patient condition, and endoscopist's skill. Clin Endosc

Issues and Prospects of Current Endoscopic Treatment Strategy for Superficial Non-Ampullary Duodenal Epithelial Tumors

“…We reported the treatment outcomes of UEMR for 65 patients with 54 lesions who underwent UEMR for SNADET at the Shizuoka Cancer Center from January 2015 to July 2020; details are shown in Table 2 [ 11 ].…”

“…However, both R0 resection and en-bloc resection rates were low in the 10–20 mm group, and the AE and residual recurrence rates were not 0%. Although the number of cases was small, both en-bloc resection and R0 resection rates were low and the AE rate and residual recurrence rates were high for lesions >20 mm [ 6 , 11 , 20 , 21 , 22 , 23 ]. If the en-bloc resection and R0 resection rates were considered important, ESD would be the better treatment; however, in the duodenum, the AE rate was regarded as more important.…”

Duodenaladenome und -karzinome: chirurgische Therapiekonzepte

“…Gemäß der ESGE wird die Größe auf < 6 mm festgelegt. Arbeiten aus dem asiatischen Raum legen ihre Grenze allerdings auf 10 mm 19 . Bei größeren nicht ampullären Befunden wird die endoskopische Mukosaresektion (EMR) empfohlen.…”

Endoscopic management of NADTs

“…Similarly, a systematic review and meta-analysis published in Endoscopy International Open in 2018 by our group, which included 14 studies, concluded that ESD may achieve higher rates of en bloc and complete resection compared to duodenal EMR, without statistically significant differences in delayed perforation rates for the two techniques [4]. Finally, the rate of complications associated with duodenal ESD has been gradually decreasing and appropriate treatment should be chosen according to lesion characteristics and local experience [5].Thus, the conclusion of the authors stating that "ESD has a limited contribution in management of duodenal adenomas" seems, from our perspective, very risky. This conclusion did not consider previous meta-analysis on this topic and is mainly based on non-pooled data about the intraoperative perforation rate, which probably has a low impact on clinically relevant outcomes, such as emergency surgery.…”

“…Similarly, a systematic review and meta-analysis published in Endoscopy International Open in 2018 by our group, which included 14 studies, concluded that ESD may achieve higher rates of en bloc and complete resection compared to duodenal EMR, without statistically significant differences in delayed perforation rates for the two techniques 4 . Finally, the rate of complications associated with duodenal ESD has been gradually decreasing and appropriate treatment should be chosen according to lesion characteristics and local experience 5 .…”