Laparoscopic‐endoscopic cooperative surgery is a safe and effective treatment for superficial nonampullary duodenal tumors

Abstract

The use of endoscopic submucosal dissection (ESD) for duodenal neoplasms has increased in recent years, but delayed perforation and bleeding are also known to frequently occur. We present two cases in which duodenal adenoma was successfully treated with laparoscopic-endoscopic cooperative surgery. ESD was combined with laparoscopic seromuscular sutures. The lesions in both cases were located in the second portion of the duodenum. The patients requested resection of the lesion, and we performed laparoscopic-endoscopic cooperative surgery. After the laparoscopic surgeon mobilized the duodenum, the endoscopic surgeon performed ESD for the duodenal tumor without perforation. The laparoscopic surgeon sutured the duodenal wall in the seromuscular layer to strengthen the ulcer bed after ESD. Histopathological studies confirmed that the surgical margins were tumor-free in both cases. The patients were discharged with no complications. This unique laparoscopic-endoscopic cooperative procedure is a safe and effective method for resecting superficial nonampullary duodenal tumors.

Laparoscopic and endoscopic cooperative surgery for non-ampullary duodenal epithelial neoplasms

“…Our LECS procedure for NADENs is consistent with the previous reports, demonstrating ESD and subsequent laparoscopic repair in the treatment of NADENs [13,14] . Complete resection of the lesions by ESD without micro-perforation theoretically enables the avoidance of tumor dissemination in the peritoneal cavity, where the precise preoperative evaluation of the depth of NADENs is inevitable.…”

“…Consequently, repair of the mucosal defect resulting from ESD is critical for the prevention of postoperative complications in LECS for NADENs. Compared with previous reports [13,14] , our procedure for LECS for NADENs is novel in terms of the repair procedure after ESD consisting of the combination of laparoscopic hand-sewn seromuscular suture and endoscopic clipping, enabling the closure of the mucosal defect from both inside and outside the duodenum [ Figure 3]. The anticipation of laparoscopic hand-sewn seromuscular sutures contributed to the reduction of the mucosal defect and therefore facilitated subsequent endoscopic clipping, compared with immediate clipping after ESD.…”

“…Duodenal stenosis occurred in the case of open conversion but was treated by repeated endoscopic balloon dilatation. ESD: endoscopic submucosal dissection In the literature [10][11][12][13][14][15] , a total seven authors reported a series of LECS for NADENs where the lesions were treated by either ESD and subsequent laparoscopic repair or endoscopy-assisted laparoscopic full-thickness resection and repair without any serious intra-and postoperative complications, corresponding to our results [ Table 3]. In those reports, surgery was occasionally performed for adenocarcinomas confined in the mucosa, but no tumor recurrence was noted in the postoperative course, revealing the feasibility of the indication of LECS for NADENs.…”

“…Similarly, recent reports demonstrated that LECS offers a promising procedure of choice to facilitate less invasive surgery in the treatment of NADENs [10][11][12][13][14][15] , but the clinical evidence verifying its efficacy remains limited. In this report, we sought to investigate our initial experience of LECS for NADENs and further reveal its clinical significance.…”

Neuroendokrine Tumoren in der täglichen gastroenterologischen und endoskopischen Praxis – ein klinisch orientierter Leitfaden

“…In ausgewählten Zentren kann hier eine endoskopische Resektion im Zuge eines endoskopisch-laparoskopischen Kombinationseingriffs unterstützt werden. Die Erfahrungen hierzu sind bisher als Einzelberichte verfügbar [60].…”