Usefulness of Endoscopic Treatment for Duodenal Adenoma

Endo, Masaki; Abiko, Yukito; Oana, Syuhei; Kudara, Norihiko; Chiba, Tetsuhiro; Suzuki, Kazuyuki; Koizuka, Hitohiko; Uesugi, Noriyuki; Sugai, Tamotsu

doi:10.1111/j.1443-1661.2010.01014.x

Cited by 71 publications

(85 citation statements)

References 10 publications

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“…They reported that 57 % of monotype lesions were category 4 lesions whereas all mixed-type lesions were category 4/5, indicating that mixed-type lesions had a significantly higher probability of being category 4/5 lesions than monotype lesions. Endo et al 29 divided classified non-ampullary duodenal tumors by convoluted, leaf, reticular/sulciolar, or colon-like pattern. In all cases, there were areas of the tumor with generalized or localized whitening.…”

Section: Discussionmentioning

confidence: 99%

Clinical usefulness of magnifying endoscopy for non-ampullary duodenal tumors

et al. 2017

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Study aims This study aimed to investigate the clinical usefulness of magnifying endoscopy (ME) for non-ampullary duodenal tumors. Patients and methods We enrolled 103 consecutive patients with non-ampullary duodenal tumors that were observed by ME with narrow-band imaging (ME-NBI) and had pit pattern analysis before endoscopic resection at Hiroshima University Hospital before December 2014. ME-NBI images were classified as Type B or Type C according to the Hiroshima classification, and pit patterns were classified as regular or irregular. We studied the clinicopathological features and diagnoses with ME-NBI and pit pattern analyses according to the Vienna classification (category 3: 73 patients; category 4: 30 patients). Results Category 4 lesions were significantly larger than category 3 lesions. According to ME-NBI images, category 4 Type C lesions (83 %) were significantly more common than category 4 Type B lesions (17 %). According to pit pattern analyses, category 4 irregular lesions 4 (77 %) were significantly more common than category 4 regular lesions (23 %). The accuracies of using Type C ME-NBI images and irregular pit patterns to diagnose category 4 lesions were 87 % and 84 %, the sensitivities were 83 % and 77 %, and the specificities were 89 % and 88 %, respectively. There was no significant difference between ME-NBI and pit pattern analyses for diagnosing the histologic grade of non-ampullary duodenal tumors. Conclusion Our study showed that ME-NBI and pit pattern analysis had equivalent abilities to determine the histologic grade of non-ampullary duodenal tumors. ME-NBI may be more useful because it is a simple, less time-consuming procedure.

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Section: Discussionmentioning

confidence: 99%

Clinical usefulness of magnifying endoscopy for non-ampullary duodenal tumors

et al. 2017

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“…Some studies reported the feasibility and outcomes of duodenal EMR/ESD in a small number of cases [12,13,14,15,16,17,18,19]. However, to our knowledge, no comparative studies have focused on the selection of ESD and EMR for achieving R0 resection.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Submucosal Dissection and Endoscopic Mucosal Resection for Non-Ampullary Superficial Duodenal Tumor

et al. 2017

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Background: Endoscopic submucosal resection (ESD) and endoscopic mucosal resection (EMR) are well established as curable and safety procedures for treating superficial tumors of the stomach, esophagus and colon. However, a majority of endoscopic resection strategies for non-ampullary superficial duodenal tumors (NASDTs) remains undefined. The aim of this study was to clarify which was the right method for NASDT treatment - EMR or ESD. Summary: We analyzed 129 consecutive endoscopic resection (74 ESD and 55 EMR) procedures performed with NADSTs and divided the ESD group into 49 large ESD groups (more than 20 mm in diameter) and 25 small ESD groups (less than 20 mm in diameter). With respect to the technical outcomes of EMR/ESD for small size NASDTs, EMR was safer than ESD, but its nature of curability was inferior to that of ESD. The rates of complication such as perforation or delayed bleeding were significantly higher in both ESD groups than in the EMR group. However, the prophylactic endoscopic closure of large mucosal defects after ESD was useful for resolving those complications. The limitations of our study were involvement of a single-center, limited sample size, short follow-up duration and the retrospective design, which may have introduced selection bias. However, the present findings suggest that adequate endoscopic treatment strategy for NASDTs can lead to favorable outcomes and an excellent prognosis. Key Message: It is necessary to select EMR or ESD adequately for R0 resection of small NASDTs, according to their size and location. For large NASDTs, duodenal ESD with essential management is feasible and useful as a therapeutic procedure.

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“…While several studies have shown the efficacy of endoscopic treatment for NADETs, the procedure is complicated by a high incidence of adverse events due to anatomical reasons [1, 4-7]. In addition, tissue sampling from NADETs through endoscopic forceps biopsy induces fibrosis, which results in difficulty on subsequent endoscopic treatment [8, 9].…”

Section: Introductionmentioning

confidence: 99%

“…Non-ampullary duodenal epithelial tumors (NADETs) are rare [1]. The prevalence of duodenal adenomas was reported to be <0.4% in subjects who underwent esophagogastroduodenoscopy [2].…”

Section: Introductionmentioning

confidence: 99%

Clinicopathological Features and Magnifying Chromoendoscopic Findings of Non-Ampullary Duodenal Epithelial Tumors

et al. 2018

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Background and Aims: We aimed to investigate an association between clinicopathological features, including immunohistochemical mucin phenotypes, and magnifying chromoendoscopic findings with crystal violet staining (ME-CV) in non-ampullary duodenal epithelial tumors (NADETs). Methods: A total of 55 patients with NADET were divided into 3 groups by mucin phenotype: intestinal, gastrointestinal, or gastric. ME-CV findings were classified into 4 patterns: convoluted, leaf-like, reticular/sulciolar, and pinecone. The clinicopathological features and ME-CV findings were compared among the mucin phenotypes. Results: Tumors of the gastric type were located in the duodenal bulb (p < 0.001), and contained pyloric gland adenoma (p < 0.001) more frequently than the other types. White-light endoscopy indicated that milk-white mucosa was less frequent in tumors of the gastric type than in those of the gastrointestinal type (p = 0.006) and the intestinal type (p < 0.001). ME-CV findings were significantly different between the gastric type and the other type (p = 0.028). Totally, 5 of 8 tumors of the gastric type manifested a pinecone pattern, 4 of which were compatible with pyloric gland adenoma. Conclusions: The endoscopic findings of NADETs differ according to mucin phenotype. A pinecone pattern under ME-CV may be characteristic of NADETs of the gastric type, especially pyloric gland adenoma.

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Usefulness of Endoscopic Treatment for Duodenal Adenoma

Cited by 71 publications

References 10 publications

Clinical usefulness of magnifying endoscopy for non-ampullary duodenal tumors

Clinical usefulness of magnifying endoscopy for non-ampullary duodenal tumors

Endoscopic Submucosal Dissection and Endoscopic Mucosal Resection for Non-Ampullary Superficial Duodenal Tumor

Clinicopathological Features and Magnifying Chromoendoscopic Findings of Non-Ampullary Duodenal Epithelial Tumors

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