Safety and efficacy of over-the-scope clip-assisted full thickness resection of duodenal subepithelial tumors: A case report

Abstract

BACKGROUNDOver-the-scope clip-assisted endoscopic full thickness resection (eFTR) of subepithelial tumors is a novel and promising endoscopic technique. Recently, there have been prospective studies investigating its use for colonic masses, but data regarding its use and efficacy in the duodenum are limited to a few reports.CASE SUMMARYA 65-year-old African American female presents for evaluation of persistent gastroesophageal reflux disease not responsive to medical treatment. A 1 cm nodule was incidentally found in the duodenum and biopsies revealed a low grade well differentiated neuroendocrine tumor. The nodule was removed using over-the-scope clip-assisted eFTR and pathology revealed clear margins. We review the available literature with a discussion on the efficacy and safety of clip-assisted eFTR s of subepithelial lesions in the duodenum.CONCLUSIONClip assisted eFTR appears to be a safe and efficacious treatment approach to duodenal subepithelial lesions. Further prospective studies are needed to investigate the long-term utility and safety of clip-assisted eFTR in the management of subepithelial duodenal lesions.

Ressecção endoscópica de tumor neuroendócrino duodenal utilizando Padlock (Over-The-Scope clipe): relato de caso em um hospital de atenção terciária

“…Porém, os procedimentos realizados geralmente são cirurgia de Whipple ou pancreaticoduodenectomia com preservação do piloro, ambas cirurgias com taxas de morbidade e mortalidade significativas. 7,13…”

Nonampullary duodenal subepithelial neuroendocrine tumor removed R0 by endoscopic submucosal dissection with double clips and rubber band traction

“…Although duodenal ESD appears challenging because of its high risk of adverse events (>20% perforation rate) and is not yet recommended, 1 we believe that we can overcome the difficulty with our DCT-ESD strategy because it was previously proved to improve colonic ESD for difficult lesions 2 . Also, it was shown to be feasible with endoscopic full-thickness resection 3 despite the fact that this technique is not yet approved for foregut lesions. Nevertheless, our DCT-ESD procedure is not time consuming and not financially burdensome.

Figure 4Endoscopic submucosal dissection specimen of submucosal neuroendocrine tumor (19EH06750).

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Spannungsfeld endoskopische Resektionsverfahren bei GEP-NET // Endoscopic resection for GEP-NET

“…Im direkten Vergleich treten interventionsbedürftige Komplikationen bei der EMR in 3% der Fälle und bei der ESD in 36 % der Fälle auf. Zum Einsatz der FTRD gibt es bisher nur einzelne Fallberichte, die aber zumindest die technische Machbarkeit belegen [23].…”