Endoscopic resection via antral submucosal tunneling for en bloc removal of tumors in the duodenal bulb

Abstract

To overcome difficulties in the removal of duodenal bulb lesions, especially those in anatomically challenging locations, we developed the endoscopic resection via antral submucosal tunneling (ERAST) technique. In this study, we evaluated the feasibility and safety of ERAST for the removal of superficial and subepithelial lesions in the duodenal bulb. This was a single‐center retrospective study of 10 patients with lesions in the bulb. Submucosal tunneling from the gastric antrum to the duodenum was performed to facilitate en bloc tumor resection in the bulb. The en bloc resection rate, postoperative bleeding, and perforation were the primary endpoints. Ten lesions (four superficial and six subepithelial), with an average size of 19.1 ± 9.2 mm, were resected en bloc by ERAST. Esophagogastroduodenoscopy follow‐up after 2 months indicated complete wound healing in all patients. In our primary experience, ERAST was found to be a feasible and safe endoscopic resection technique for the removal of lesions in the duodenal bulb, especially those that are difficult to access.

Same duodenal neuroendocrine tumors, different endoscopic resection methods: a case report and literature review

“…Despite its efficacy, the potential for submucosal tunneling injuries should not be overlooked. Luo et al ( 9 ) reported a 100% success rate in en bloc resection for lesions in the duodenal bulb via STER, with no significant bleeding and only a minor micro-perforation, approximately 3 mm in width. However, these findings, while promising, underscore the necessity for larger clinical studies to validate the safety and effectiveness of STER in broader patient populations.…”

“…Additional treatment modalities include immunotherapy, peptide receptor radioligand therapy, somatostatin analog therapy, symptomatic management, and endoscopic resection. In China, the methods of endoscopic resection, including endoscopic submucosal excavation (ESE) ( 7 ), endoscopic submucosal dissection (ESD) ( 8 ), and submucosal tunneling endoscopic resection (STER) ( 9 ) are increasingly favored for treating these smaller and less invasive NETs, due to their reduced risk of complications. Moreover, endoscopic resection serves as an intermediate strategy that bridges the gap between a “watch-and-wait” approach and surgery according to the horizontal and vertical margins.…”

Data_Sheet_1.PDF

“…Additional treatment modalities include immunotherapy, peptide receptor radioligand therapy, somatostatin analog therapy, symptomatic management, and endoscopic resection. In China, the methods of endoscopic resection, including endoscopic submucosal excavation (ESE) (7), endoscopic submucosal dissection (ESD) (8), and submucosal tunneling endoscopic resection (STER) (9) are increasingly favored for treating these smaller and less invasive NETs, due to their reduced risk of complications. Moreover, endoscopic resection serves as an intermediate strategy that bridges the gap between a "watch-and-wait" approach and surgery according to the horizontal and vertical margins.…”