Management of perforation related to endoscopic submucosal dissection for superficial duodenal epithelial tumors

Fukuhara, Seiichiro; Kato, Motohiko; Iwasaki, Eisuke; Sasaki, Motoki; Tsutsumi, Kimiko; Kiguchi, Yoshiyuki; Akimoto, Teppei; Takatori, Yusaku; Nakayama, Atsushi; Maehata, Tadateru; Minami, Kazuhiro; Ogata, Haruhiko; Kanai, Takanori; Yahagi, Naohisa

doi:10.1016/j.gie.2019.09.024

Cited by 47 publications

(71 citation statements)

References 31 publications

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“…Furthermore, all duodenal ESD models without intraoperative perforation resulted in delayed perforation. In humans, delayed perforation after duodenal ESD is associated with the duodenal wall thinness and exposure to bile and pancreatic juice 6,17 . However, mucosal defects without suture after dissection were similar in the two models.…”

Section: Discussionmentioning

confidence: 86%

“…In addition, each method has some limitations. For example, closure methods are sometimes difficult for large mucosal defects 6 . Delayed perforation might occur when clips drop out even after successful clip closures.…”

Section: Discussionmentioning

confidence: 99%

“…However, a high rate of intraoperative and postoperative perforation occurs with ESD for SNADETs, 2–4 which is possibly induced by ischemic changes or necrosis due to dissection of thin duodenal mucosa 5 . In addition, exposure to pancreatic juice and bile likely participates in delayed perforation 6 . To date, a few studies have reported on the prevention of delayed perforation in duodenal ESD such as over‐the‐scope‐clip (OTSC) closure, polyglycolic acid (PGA) sheets with fibrin glue, and endoscopic nasobiliary/pancreatic duct drainage 6–9 .…”

Section: Introductionmentioning

confidence: 99%

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Establishment of an in‐vivo porcine delayed perforation model after duodenal endoscopic submucosal dissection

Hashiguchi¹,

Maruya

Matsumoto³

et al. 2020

Digestive Endoscopy

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Objectives Duodenal endoscopic submucosal dissection (ESD) for superficial non‐ampullary duodenal epithelial tumors has a significant incidence rate of delayed perforation. Although several methods have been proposed to prevent delayed perforation, the most appropriate methods remain unclear. Currently, there is no appropriate animal model to validate methods for preventing duodenal delayed perforation. This study aimed to establish an in‐vivo porcine delayed perforation model after duodenal submucosal dissection. Methods Two porcine models underwent either ESD or surgical submucosal dissection. In the surgical dissection model, an inverted duodenal mucosa was resected with electrosurgical energy. In the ESD model, a gauze was placed behind the duodenum with grasped transverse part to improve endoscopic maneuverability. The mucosal defects after dissection were treated with omental coverage without suture in both models. All models were euthanized 0–5 days after procedure. Body weight; resection size; procedure dissection time; presence of intraoperative perforation and delayed perforation; and adhesion score were assessed. Results There were no significant differences in body weight and adhesion score between the two models. Resection size was significantly larger in the surgical dissection models than in the ESD models (19 mm vs 14.3 mm, P < 0.01). Procedure time was significantly longer in the ESD models than in the surgical models (45.2 minutes vs 4.5 minutes, P < 0.01). Delayed perforation rates in the surgical dissection models and the ESD models were 0% (0/5) and 100% (5/5), respectively (P < 0.01). Conclusions This study indicated that our in‐vivo porcine duodenal ESD model is beneficial to evaluate a prevention strategy for delayed perforation.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Establishment of an in‐vivo porcine delayed perforation model after duodenal endoscopic submucosal dissection

Hashiguchi¹,

Maruya

Matsumoto³

et al. 2020

Digestive Endoscopy

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“…The ENBPD is reportedly effective for treating anastomotic leakage after duodenal surgery 2 and perforation during duodenal endoscopic submucosal dissection 3 . ENBPD avoids exposing a duodenal wound to bile and pancreatic juice, facilitating wound healing, and was useful in our patient to prevent recurrent bleeding.…”

Section: Figurementioning

confidence: 76%

Endoscopic naso‐biliary and ‐pancreatic duct drainage for refractory post‐bulbar duodenal ulcer bleeding

Shoji¹,

Shichijo²,

Fukutake

2020

Digestive Endoscopy

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“…However, due to the thin wall of the duodenum and its rich blood vessels, most tumors invade the submucosa. Therefore, duodenal endoscopic submucosal dissection is truly challenging, and even Japanese experts think twice before indicating [11], because there are risks of bleeding, perforation, positive margins, and missed metastatic lymph nodes in endoscopic resection treatment [8,9,[12][13][14][15][16]. Some studies reported that the lymphatic metastasis rate of d-NET with a tumor of 1-2 cm in diameter was approximately 60% [17,18].…”

Section: Discussionmentioning

confidence: 99%

How to Choose the Best Procedure Type for Duodenal Neuroendocrine Tumors With a Maximum Diameter of 1 to 2 Cm a Propensity Score Matching Analysis Based on the SEER Database

Tang

Xie

Pang

et al. 2020

Preprint

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Background: The treatment plan for duodenal neuroendocrine tumors (d-NETs) with a diameter between 1 and 2 cm is still controversy. Aim: To compare the effects of local endoscopic resection and radical resection on the prognosis of d-NETs with a maximum diameter of 1-2 cm. Methods: 286 eligible patients were identified from the SEER database. Propensity score matching (PSM) was done to match patients 1:1 on clinicopathological characteristics. Kaplan-Meier analysis was used to analyze the factors affecting the prognosis.Results: Before PSM, there was no significant difference in the cancer-specific survival (CSS) between the two groups (P = 0.595), but the tumor size, T stage, N stage, and M stage were significantly different between the two groups (all P < 0.05). After 1:1 PSM, the differences in clinicopathological characteristics between the two groups were significantly reduced (all P > 0.05). Survival analysis showed that only the tumor grade was correlated with the prognosis (P = 0); surgical method and other clinicopathological characteristics were not correlated with the prognosis (all P > 0.05). Conclusion: The surgical approach had no significant effect on the prognosis of d-NET patients with a maximum diameter of 1-2 cm and without lymph node metastasis.

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Management of perforation related to endoscopic submucosal dissection for superficial duodenal epithelial tumors

Cited by 47 publications

References 31 publications

Establishment of an in‐vivo porcine delayed perforation model after duodenal endoscopic submucosal dissection

Establishment of an in‐vivo porcine delayed perforation model after duodenal endoscopic submucosal dissection

Endoscopic naso‐biliary and ‐pancreatic duct drainage for refractory post‐bulbar duodenal ulcer bleeding

How to Choose the Best Procedure Type for Duodenal Neuroendocrine Tumors With a Maximum Diameter of 1 to 2 Cm a Propensity Score Matching Analysis Based on the SEER Database

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