Appropriate endoscopic treatment selection and surveillance for superficial non-ampullary duodenal epithelial tumors

Hirasawa, Kingo; Ozeki, Yuichiro; Sawada, Atsushi; Sato, Chiko; Ikeda, Ryosuke; Nishio, Masafumi; Fukuchi, Takehide; Kobayashi, Ryosuke; Makazu, Makomo; Taguri, Masataka; Maeda, Shin

doi:10.1080/00365521.2020.1867896

Cited by 15 publications

(30 citation statements)

References 29 publications

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“…It is important to consider the resectability of each treatment method and the risk of adverse events when considering the indications for treatment. ESD is reported to accomplish secure en bloc resection for superficial epithelial tumors arising from the gastrointestinal tract irrespective of the size and location [11][12][13][14] . Similarly, duodenal ESD accomplishes higher en bloc resection rates in previous reports [15][16][17][18][19][20][21][22] .…”

Section: Indications For Esd and Cure Criteriamentioning

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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Section: Indications For Esd and Cure Criteriamentioning

confidence: 99%

ESD for duodenal carcinoma

Kato¹,

Sasaki²,

Maehata³

et al. 2022

MIS

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show abstract

“…Similarly, in the duodenum, ESD has been reported to achieve a high en bloc resection rate, regardless of the size of the lesion. 17 , 19 , 22 , 23 , 24 , 25 , 31 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 Secure local resectability is one of the greatest advantages of ESD for reducing local residual recurrence. In fact, it has been reported that local recurrence occurs up to 30% of large lesions in the duodenum when the resection results in piecemeal resection 22 , 24 , 58 , 59 , 60 , 61 , 62 (Table 3 ).…”

Section: Endoscopic Submucosal Dissectionmentioning

confidence: 99%

“…On the other hand, it has been reported that ESD for SNADET is technically challenging, especially with an extremely high risk of AE with a reported bleeding rate of more than 20% and perforation rate up to about 40% 17 , 19 , 22 , 23 , 24 , 25 , 31 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 (Table 2 ). Factors that make duodenal ESD technically difficult include the following: maneuverability of the endoscope is limited in the duodenum, which is far from the mouth and fixed to the retroperitoneum.…”

Section: Endoscopic Submucosal Dissectionmentioning

confidence: 99%

“…There is a concern that the risk of perforation might be increased in UEMR by not performing local injection into the submucosa. However, in fact, intraoperative perforation of UEMR is reported to be very rare [26][27][28][29][30][31][32] (Table 1). This may be because, unlike the semilunar folds of the colon, the duodenal Kerckring folds consist of only mucosa and submucosa and do not contain the muscularis propria.…”

Section: Underwater Emrmentioning

confidence: 99%

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Endoscopic resection of superficial non‐ampullary duodenal epithelial tumor

2021

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Although superficial non‐ampullary duodenal epithelial tumor (SNADET) was previously considered a rare disease, in recent years, the opportunities to detect and treat SNADET are increasing. Considering the high morbidity of pancreatoduodenectomy, endoscopic resection can be a treatment option that preserves the organs and contributes maintain patients’ quality of life. Endoscopic mucosal resection (EMR) is a standard treatment for relatively small lesions in gastrointestinal tracts, however, it is difficult because submucosal fibrosis frequently occurs due to the previous biopsy. Recently, some modified EMR techniques including underwater EMR (UEMR) and cold polypectomy (CP) have been proposed. In UEMR, the duodenal lumen is filled with water or saline and resected the targe lesion with a snare without injection into the submucosa. It would be a treatment option that could reduce candidates for ESD especially SNADET less than 20 mm. CP was reported as a safe and convenient means for SNADET. It would also be one of the standard treatments for diminutive lesions, though there remain some concerns on its resectability. ESD for SNADET is technically challenging, especially with an extremely high risk of adverse event (AE) with a reported bleeding rate of more than 20% and perforation rate up to about 40%. However, modified treatment techniques including the water pressure method and pocket creation method have been reported to potentially contribute to improving outcomes of ESD. Moreover, accumulated evidence shows closing the mucosal defect significantly reduces delayed adverse events after duodenal endoscopic treatments. Further studies are warranted to elucidate curative criteria, long‐term outcomes, and appropriate surveillance strategy.

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“…Second, the authors found that endoscopic submucosal dissection (ESD) had a lower local recurrence rate compared with non-ESD resection methods, especially for large duodenal tumors ( ≥ 30 mm). In another recent study, however, incomplete resection was more likely to occur in larger lesions and local recurrence was more likely to be found at follow-up [4]. The key issue may lie in whether the local recurrence rate of ESD and non-ESD methods is similar for small lesions, which could further reflect the long-term outcomes of non-ESD resection methods.…”

mentioning

confidence: 94%

Endoscopic treatment selection for superficial duodenal tumors: pay attention to small lesions

Yang

2022

Endoscopy

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Appropriate endoscopic treatment selection and surveillance for superficial non-ampullary duodenal epithelial tumors

Cited by 15 publications

References 29 publications

ESD for duodenal carcinoma

ESD for duodenal carcinoma

Endoscopic resection of superficial non‐ampullary duodenal epithelial tumor

Endoscopic treatment selection for superficial duodenal tumors: pay attention to small lesions

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