Safety and feasibility of laparoscopic and endoscopic cooperative surgery for duodenal neoplasm: a retrospective multicenter study

Nunobe, Souya; Ri, Motonari; Yamazaki, Kaoru; Uraoka, Masanao; Ohata, Ken; Kitazono, Iwao; Terashima, Masanori; Yamagata, Yukinori; Tanabe, Satoshi; Abe, Nobutsugu; Tsuji, Toshikatsu; Niimi, Keiko; Kawakubo, Hirofumi; Tsukada, Tomoya; Kitashiro, Shuji; Ishizuka, Naoki; Hiki, Naoki

doi:10.1055/a-1327-5939

Cited by 24 publications

(29 citation statements)

References 15 publications

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“…Most patients (74.4 %) were followed up without treatment, and the remaining 25.6 % of patients underwent treatment such as ER or surgical resection (SR) after being followed up for ≥ 6 months. There were 8 lesions (6.4 %) that required SR, all of which were local resection including laparoscopic and endoscopic cooperative surgery (LECS) 22 . The reasons for SR were large size (> 20 mm) in four lesions and poor endoscopic maneuverability in four lesions.…”

Section: Resultsmentioning

confidence: 99%

Sporadic non-ampullary duodenal adenoma with low-grade dysplasia: Natural history and clinical management

et al. 2022

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Background and study aims Management strategies for sporadic non-ampullary duodenal adenoma with low-grade dysplasia (LGD) are not well established. This study aimed to analyze progression factors and determine suitable treatment strategies for LGD lesions. Patients and methods We retrospectively analyzed consecutive LGD lesions (n = 125) in patients followed up for ≥ 6 months (median, 45 months) and evaluated the changes in clinicopathological features during follow-up. All LGD lesions were classified into two groups: stable LGD (no increase or < 5 mm increase in tumor size, with unchanged histological dysplasia grade) and progressive LGD (≥ 5 mm increase in tumor size and/or progression to high-grade dysplasia or adenocarcinoma). Results Eighty-six LGD were classified as stable and 39 as progressive. Location on the oral side of the papilla of Vater, large initial tumor size ( ≥ 10 mm), macroscopically complex type, red color, and nodularity were significantly frequent in progressive LGD than in stable LGD. In multivariate analysis, large initial tumor size (odds ratio [OR], 10.2; 95 % confidence interval [CI], 3.3–32.1; P < 0.001) and location on the oral side of the papilla of Vater (OR: 1.8, 95 % CI: 1.4–12.5; P = 0.012) were significant factors for progression. Moreover, initial tumor size < 5 mm rarely progressed (0%–3.9 %); however, initial tumor size ≥ 20 mm and 10–19 mm located on the oral side of the papilla of Vater had a high-risk progression rate (75.0–85.7 %). Conclusions According to the risk stratification of progression factors by initial tumor size and location, we can determine suitable treatment indications for LGD lesions.

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Section: Resultsmentioning

confidence: 99%

Sporadic non-ampullary duodenal adenoma with low-grade dysplasia: Natural history and clinical management

et al. 2022

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“…This technique is believed to compensate for the high perforation rate in ESD with reinforcement using seromuscular sutures at the mucosal defect site. Nunobe et al [ 29 ] showed that the rates of en bloc and R0 resection during D-LECS were 96% (198/206) and 95% (196/206), respectively. In this study, D-LECS had the same indications as ESD in duodenal tumors, for example, adenoma and mucosal adenocarcinoma without around the ampulla of Vater.…”

Section: Treatments For Snadetsmentioning

confidence: 99%

Current Treatment Strategy for Superficial Nonampullary Duodenal Epithelial Tumors

et al. 2022

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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

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“…Another way to prevent delayed AE is suturing the wound from the peritoneal side by laparoscopy assistance in addition to flexible endoscopy from inside the duodenum lumen. This novel surgical procedure, named endoscopic cooperative surgery (D-LECS), was first reported in 2015 [42] . A retrospective case series with 206 cases undergoing D-LECS revealed 95% R0 resection rate, 1.5% perforation rate, and 1% bleeding rate, suggesting favorable outcomes [43] .…”

Section: Suturingmentioning

confidence: 99%

ESD for duodenal carcinoma

Kato¹,

Sasaki²,

Maehata³

et al. 2022

MIS

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Superficial non-ampullary duodenal epithelial tumors (SNADETs) are rare, but their incidence is increasing recently. Considering the invasiveness of pancreatoduodenectomy, endoscopic treatment is widely accepted as an option for maintaining patients’ quality of life. SNADETs larger than 20 mm are an indication for duodenal ESD, and intramucosal cancer can be cured by ESD. Duodenal ESD is extremely difficult with a high risk of adverse events. However, some modified treatment techniques such as the water pressure method or the pocket creation method have been proposed to improve outcomes. Furthermore, evidence is accumulating that protection of the mucosal defect reduces delayed adverse events after duodenal endoscopic treatments. Moreover, endoscopic drainage of the bile and pancreatic juice is effective as conservative management even in cases with delayed perforation.

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Safety and feasibility of laparoscopic and endoscopic cooperative surgery for duodenal neoplasm: a retrospective multicenter study

Cited by 24 publications

References 15 publications

Sporadic non-ampullary duodenal adenoma with low-grade dysplasia: Natural history and clinical management

Sporadic non-ampullary duodenal adenoma with low-grade dysplasia: Natural history and clinical management

Current Treatment Strategy for Superficial Nonampullary Duodenal Epithelial Tumors

ESD for duodenal carcinoma

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