Usefulness and safety of endoscopic treatment for nonampullary duodenal adenoma and adenocarcinoma

Seo, Jung Yeon; Hong, Su Jin; Han, Jae Pil; Jang, Hee Yoon; Myung, Yu Sik; Kim, Cheol; Lee, Yun Nah; Ko, Bong Min

doi:10.1111/jgh.12601

Cited by 28 publications

(20 citation statements)

References 46 publications

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“…Basically, incidence of complications after ER for SNADETs was significantly higher than that in any other part of the digestive tract [15,25,26]. This is due to the anatomical features, which include the following: a narrow lumen; a precipitous flexure that causes poor stability of the endoscope; Brunner's glands in the submucosal layer that stiffen the duodenal wall, resulting in poor mucosal lifting; a thin muscle layer that results in a higher incidence of intraoperative perforation and increased risk of other complications such as postoperative bleeding and delayed perforation; and difficult access if emergency surgery becomes necessary [2,9,27]. Risk of intraoperative and delayed perforation was reported not based on location of SNADETs but on the tumor size [23].…”

Section: Discussionmentioning

confidence: 99%

“…Superficial non-ampullary duodenal epithelial tumors (SNA-DETs) are defined as sporadic adenoma and adenocarcinoma that are confined to the mucosa or submucosa that do not arise from the ampulla of Vater [1]. Because of the rarity of SNADETs [2], their etiology, prevalence, and risk factors remain unknown. It was reported that SNADETs were detected using esophagogastroduodenoscopy (EGD) in adult patients at a rate of 0.1 % to 0.3 % [3].…”

Section: Introductionmentioning

confidence: 99%

“…Malignant transformation is another problem of SNADETs. Duodenal adenoma was reported to be a precancerous lesion with a relatively high rate of canceration [2]. Some reports sug-Clinical outcomes of endoscopic resection for superficial non-ampullary duodenal tumors ABSTR AC T Background and study aims Because superficial non-ampullary duodenal epithelial tumors (SNADETs) are relatively rare, studies evaluating the outcomes of endoscopic resec-tion (ER) for SNADETs are limited.…”

Section: Introductionmentioning

confidence: 99%

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Clinical outcomes of endoscopic resection for superficial non-ampullary duodenal tumors

et al. 2020

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Background and study aims Because superficial non-ampullary duodenal epithelial tumors (SNADETs) are relatively rare, studies evaluating the outcomes of endoscopic resection (ER) for SNADETs are limited. Therefore, this study aimed to evaluate the clinical validity of ER for SNADETs. Patients and methods The study participants included 163 consecutive patients (108 men; mean age, 61.5 ± 11.3 years) with 171 SNADETs, excluding patients with familial adenomatous polyposis resected by ER, at Hiroshima University Hospital between May 2005 and September 2016. Clinicopathological features and the outcomes of ER for 171 cases were retrospectively analyzed. Additionally, the prognosis of 135 patients with more than 12 months’ follow-up was analyzed. Results Mean diameter of SNADETs was 10.7 ± 7.2 mm. Most of the SNADET cases were classified as category 3 (71 %, 121/171), but some were category 5 (2 %, 3/171). En bloc resection rates were 93 % (146/157), 100 % (7/7), and 86 % (6/7) in endoscopic mucosal resection (EMR), polypectomy, and in endoscopic submucosal dissection (ESD) cases, respectively. Complete resection rates were 90 % (141/157), 100 % (7/7), and 71 % (5/7) in EMR, polypectomy, and ESD cases, respectively. Emergency surgery was performed in two patients with intraoperative perforation and in two with delayed perforation without artificial ulcer bed closure after ER. Since endoscopic closure of ulcer by clipping was performed, delayed perforation has not occurred. Local recurrence occurred in 1.2 %, but no metastasis to lymph nodes or other organs occurred after ER. No patient died of primary SNADETs. Conclusion Our data supported the clinical validity of ER for SNADETs. However, delayed perforation should be given much attention.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical outcomes of endoscopic resection for superficial non-ampullary duodenal tumors

et al. 2020

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“…Management of a duodenal injury associated with percutaneous kidney access gaining was well described so far and ranged from surgical options including laparotomy to conservative, with prolonged fasting up to 14 days, parenteral hyperalimentation, and prolonged hospital stay [5, 6]. Despite the fact that the location of the duodenal defect directed our surgical team towards open surgery experience of our endoscopist, who is managing duodenal adenocarcinoma endoscopically [7] and the size of the defect was taken into consideration.…”

Section: Discussionmentioning

confidence: 99%

Novel Approach for Endoscopic Management of Duodenal Injury during Perirenal Infected Haematoma Drainage after Shock-Wave Lithotripsy

Gadzhiev

Gorelov

Смирнов

et al. 2018

Case Reports in Urology

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Background. Gaining percutaneous access during percutaneous nephrolithotomy (PNL) can be complicated with the bowel injury. We report a novel approach of management of duodenal injury complicating percutaneous drainage of infected haematoma after Shock-Wave Lithotripsy (SWL). Case Presentation. A 57-year-old patient with the 15 mm right pelvic kidney stone underwent uneventful SWL. Patient visited emergency department 3 days later with high fever and chills with severe right flank pain. CT urography revealed lower pole kidney injury with signs of infected hematoma due to low attenuation areas but without signs of obstruction or urine leakage. Infected haematoma was drained percutaneously under ultrasound and X-ray control and a pigtail catheter 10 Fr was left beneath the lower pole of the right kidney. Postoperatively duodenal injury was suspected due to amber color, low creatinine, and high bilirubin level in the drainage output. CT demonstrated that the pigtail of the drain had entered the second part of the duodenum. Catheter was withdrawn and defect of the duodenal wall was stapled with four staples endoscopically. After 2 days of fasting patient was allowed to start oral food intake and was discharged on the 5th day. Conclusion. Injury of the duodenum during percutaneous kidney manipulation is an extremely rare complication. Conservative management consisting of endoscopic stapling of the duodenal wall defect is a safe and feasible approach to expediting the recovery of the patient.

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“…Delayed perforation is a rare (0.4% 7 ), but serious, complication of colorectal ESD, possibly requiring emergency surgery. The intraoperative perforation rate of duodenal ESD was reported to range from 6.3% to 75%, [25][26][27][28] and delayed perforation of duodenal ESD may require emergency surgical treatment or cause a negative clinical course. Therefore, the prevention of postoperative perforation is important.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic closure after intraluminal surgery

Akimoto

Goto

Nishizawa

et al. 2017

Digestive Endoscopy

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Endoscopic submucosal dissection is established as a curative endoscopic method for gastrointestinal epithelial neoplasms with a high possibility of complete en bloc resection; however, postoperative adverse events of bleeding and delayed perforation remain. To prevent or minimize them, several techniques for endoscopic mucosal closure have been introduced, such as using endoscopic clips, combined use of hemoclips and supplement devices, and specially designed endoscopic suturing devices. Furthermore, endoscopic full-thickness suturing technique for gastrointestinal wall defect has been developed based on the concept in natural orifice transluminal endoscopic surgery and endoscopic full-thickness resection. Several closure techniques, including over-the-scope clip, threaded bars inserted in a hollow needle, stitches or staplers, and a curved needle and thread are reported. Secure closure of the iatrogenic defect may further expand the range of therapeutic endoscopy. Accumulation of evidence for the efficacy of endoscopic closure and establishment of these techniques are desired.

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Usefulness and safety of endoscopic treatment for nonampullary duodenal adenoma and adenocarcinoma

Abstract: Endoscopic treatment is minimally invasive management for duodenal adenomas and superficial adenocarcinomas. It would be helpful for medical doctors in the management of duodenal neoplasms.

Cited by 28 publications

References 46 publications

Clinical outcomes of endoscopic resection for superficial non-ampullary duodenal tumors

Clinical outcomes of endoscopic resection for superficial non-ampullary duodenal tumors

Novel Approach for Endoscopic Management of Duodenal Injury during Perirenal Infected Haematoma Drainage after Shock-Wave Lithotripsy

Endoscopic closure after intraluminal surgery

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