Short- and long-term outcomes of endoscopically treated superficial non-ampullary duodenal epithelial tumors

Hara, Yuko; Goda, Kenichi; Dobashi, Akira; Ohya, Tomohiko R.; Kato, Masayuki; Sumiyama, Kazuki; Mitsuishi, Takehiro; Hirooka, Shinichi; Ikegami, Machiko; Tajiri, Hisao

doi:10.3748/wjg.v25.i6.707

Cited by 56 publications

(75 citation statements)

References 37 publications

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“…The muscle layer of the duodenum is thinner than that in the stomach and colon and is prone to perforation during submucosal dissection [8]. In previous studies, duodenal ESD has been associated with a 21-72.7% rate of perforation, which is notably higher than that of EMR [9,13,[17][18][19][20][21]. In the current study, the perforation rate in patients undergoing ESD was unacceptably high at 45.5%, and 80% of them required additional surgery.…”

Section: Discussionmentioning

confidence: 48%

Clinical Outcomes following Endoscopic Treatment for Sporadic Nonampullary Duodenal Adenoma

Na¹,

Kim²,

Ahn³

et al. 2020

Dig Dis

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Background and Aims: Endoscopic treatment for duodenal neoplasms is associated with a high risk of perforation. This study aimed to determine the feasibility of endoscopic treatment for sporadic nonampullary duodenal adenoma (SNDA). Methods: Consecutive patients undergoing endoscopic treatment for SNDA between January 2005 and December 2015 were included in the study. Clinical characteristics and endoscopic outcomes were analyzed using medical records. Long-term outcome was assessed in patients whose followup period was > 12 months > 1 year. Results: A total of 95 lesions (92 patients) were treated with argon plasma coagulation (APC) ablation (n = 25), endoscopic mucosal resection (EMR, n = 59), or endoscopic submucosal dissection (ESD, n = 11). The median age was 54.9 years, and 63% were male. In patients who underwent EMR and ESD, the en bloc resection rate was 83.1 and 90.0% (p > 0.99); and the complete resection rate was 81.4 and 80% (p > 0.99), respectively. Perforation occurred in 8 patients (8.7%), 4 of whom required surgery. The ESD group showed a significantly higher perforation rate than APC or EMR group (45.5 vs. 0 and 5.1%; p < 0.001). During the median follow-up period of 19 months (range 12-137 months), one patient in the APC ablation group experienced recurrence; no recurrences were seen among EMR and ESD groups. Conclusions: Favorable longterm outcomes indicate that endoscopic treatment is an effective approach for the treatment of SNDA. Considering the high risk of perforation associated with ESD, APC, or EMR may be an acceptable alternative.

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Section: Discussionmentioning

confidence: 48%

Clinical Outcomes following Endoscopic Treatment for Sporadic Nonampullary Duodenal Adenoma

Na¹,

Kim²,

Ahn³

et al. 2020

Dig Dis

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“…In this study, NADCs were male predominant (71%). Previous studies also reported male predominance by a men–women ratio of around 1.2–2:1 . The reason for male predominance is unknown; however, similar reasons may be considered as other cancers of the digestive tract such as esophageal, gastric, and colorectal cancers, which are similarly predominant among men than women .…”

Section: Discussionmentioning

confidence: 91%

“…Many duodenal adenomas may follow the adenoma–carcinoma sequence, but the natural history still remains unknown. Considering the risk of bleeding and perforation of endoscopic resection, high‐grade adenoma and carcinoma with no risk of metastasis are suitable candidates for endoscopic resection, whereas low‐grade adenoma may be followed up …”

Section: Introductionmentioning

confidence: 99%

Endoscopic features of submucosal invasive non‐ampullary duodenal carcinomas

Takinami

Kakushima

Yoshida

et al. 2019

J of Gastro and Hepatol

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Background and Aim: It is imperative to distinguish superficial non-ampullary duodenal carcinomas (NADCs) between intramucosal and submucosal invasive carcinoma for treatment selection. The aim of this study was to evaluate the clinicopathological differences of intramucosal and submucosal carcinoma. Methods: This was a retrospective, single-center study comprising 134 patients with 137 superficial NADCs during May 2005 and March 2018. Clinicopathological characteristics and treatment outcomes data were used to perform a comparative analysis of endoscopic findings, preoperative diagnoses of depth of cancer, and treatment outcomes of histologically diagnosed intramucosal and submucosal carcinoma. Results: Of the 137 NADCs, 125 (91%) were intramucosal, and 12 (9%) were submucosal. The proportion of submucosal carcinoma was significantly higher on the oral side of the papilla than on the anal side (16% vs 1%, P = 0.002). Submucosal tumor-like appearance was more frequent in submucosal than in intramucosal carcinoma (58% vs 13%, P = 0.001). There was no significant difference in tumor diameter between the groups, but 33% of submucosal carcinomas were ≤ 10 mm. Correct preoperative diagnosis of depth was achieved in 33% of submucosal carcinoma. Submucosal carcinoma was frequently underestimated when tumor diameters were ≤ 10 mm. Conversely, intramucosal carcinoma was frequently overestimated when the tumor was ≥ 30 mm and had thickness or giant nodules. Lymph node metastasis was found in one submucosal carcinoma patient. Conclusions:The possibility of submucosal invasion should be considered when NADCs are located on the oral side of the papilla or have submucosal tumor-like appearance even if tumor diameters are ≤ 10 mm.

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“…EMR of duodenal adenomas has been shown to be effective in several studies over the past decade [5][6][7][8][9][10][15][16][17]. Substantial complication rates have been described especially after resection of large and giant lesions.…”

Section: Discussionmentioning

confidence: 99%

“…Published studies mostly describe retrospective series with long inclusion periods [8][9][10]. Several attempts have been made to reduce the rate of delayed complications, including clipping or coagulation of visible vessels, various techniques for closure of the resection site, and stenting of the pancreatic duct.…”

Section: Introductionmentioning

confidence: 99%

Complication risk despite preventive endoscopic measures in patients undergoing endoscopic mucosal resection of large duodenal adenomas

et al. 2020

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Background Endoscopic mucosal resection (EMR) is the standard treatment of ampullary and nonampullary duodenal adenomas. EMR of large (10–29 mm) and giant (≥ 30 mm) lesions carries a risk of complications such as delayed bleeding and perforation. Prospective data on duodenal EMR are scarce. This study aimed to evaluate the efficacy of endoscopic procedures (clipping and coagulation of visible vessels) to prevent complications after EMR of large and giant lesions. Methods 110 patients with 118 adenomas (29 ampullary and 89 nonampullary) were included prospectively. Results 15 lesions were small (12.7 %), 68 were large (57.6 %), and 35 were giant (29.7 %). Endoscopic prevention of delayed complications was performed in 81.4 % (n = 96) of all lesions and 94.3 % (n = 33) of giant lesions. Complete resection was achieved in 111 lesions (94.1 %). Complications were 22 delayed bleedings (18.6 %), 3 intraprocedural perforations (2.5 %), 2 delayed perforations (1.7 %), and 1 stricture (0.8 %). Major complications were associated with lesions size ≥ 30 mm (28.6 % vs. 9.6 %; P = 0.02) and ampullary adenomas (27.6 % vs. 11.2 %; P = 0.07). All minor bleeding and 75 % of major bleeding episodes were treated endoscopically; 25 % of major bleedings needed radiologic embolization. Two fatal courses were observed when delayed perforation occurred after EMR of giant lesions. Residual adenoma was detected in 20.4 % at first follow-up. Conclusions EMR of giant duodenal neoplasia carries a substantial risk of major complications and recurrences. Resection technique and prevention of delayed complications need to be improved. Further measures should be evaluated in randomized studies.

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Short- and long-term outcomes of endoscopically treated superficial non-ampullary duodenal epithelial tumors

Cited by 56 publications

References 37 publications

Clinical Outcomes following Endoscopic Treatment for Sporadic Nonampullary Duodenal Adenoma

Clinical Outcomes following Endoscopic Treatment for Sporadic Nonampullary Duodenal Adenoma

Endoscopic features of submucosal invasive non‐ampullary duodenal carcinomas

Complication risk despite preventive endoscopic measures in patients undergoing endoscopic mucosal resection of large duodenal adenomas

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