Clinical course and management of adverse events after endoscopic resection of superficial duodenal epithelial tumors: Multicenter retrospective study

Superficial duodenal epithelial tumors (SDETs) have been considered relatively rare, compared with other gastrointestinal cancers. 1 Most nonpapillary duodenal tumors are asymptomatic. They are usually difficult to detect. However, esophagogastroduodenoscopy is often performed for patients with minor symptoms in Japan, and the number of detected cases is increasing due to advances in endoscopic equipment, including improvements in resolution. 2,3 Endoscopic resection (ER) for SDETs has been diversified from conventional endoscopic mucosal resection (EMR) to cold snare polypectomy, underwater EMR (UEMR), and endoscopic submucosal dissection (ESD). While ER is less invasive to the patient than surgery, it may be difficult for cases involving the duodenum due to anatomical effects, the thin intestinal wall, and delayed adverse events (AEs) resulting from exposure to the bile and pancreatic juice. 4 Familiarity with the course and management of AEs is extremely important. There have been reports of AEs after ER for SDETs in Japan, East Asia, and Western countries. However, these reports are for small samples; therefore, the literature on the clinical course of AEs is limited. 5,6 Dohi et al. 7 conducted a multicenter retrospective study to investigate the clinical course and management of AEs after ER for SDETs. Their study involved 3000 SDETs and represents the largest on the clinical course of AEs after ER. The ER methods in this study included cold snare polypectomy, conventional EMR, UEMR, and ESD. Of the 3047 patients enrolled, 226 had AEs such as intraoperative perforation, postoperative bleeding, and delayed perforation, most of which were ESD-related for ER. Intraoperative perforation and delayed perforation, which can be particularly serious, are more frequently encountered in ESD procedures compared to other ER methods. Therefore, it is crucial to select the appropriate ER method based on the size and qualitative diagnosis of the lesion to minimize the risk of perforation. 8% (18/226) of AEs required surgical conversion perioperatively. The number of cases requiring surgical conversion for each AE is as follows. Intraoperative perforation accounted for 3.7% (4/108), delayed bleeding accounted for 1.0% (1/99), delayed perforation accounted for

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Underwater clip closure method for mucosal defects after duodenal endoscopic submucosal dissection (with video)

Ishida,

Dohi,

Seya

et al. 2023

Digestive Endoscopy

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Conventional clip closure of mucosal defects after duodenal endoscopic submucosal dissection decreases the incidence of delayed adverse events, but may result in incomplete closure, depending on size or location. This study aimed to assess the effectiveness of the underwater clip closure method for complete duodenal defect closure without the difficulties associated with conventional closure methods. We investigated 19 patients with 20 lesions who underwent endoscopic submucosal dissection of the duodenum and subsequent mucosal defect closure in underwater conditions at our facility between February 2021 and January 2022. The success rate of the underwater clip closure method was defined as the complete endoscopic closure of the mucosal defect; a success rate of 100% was achieved. The median resected specimen size was 34.3 mm, the median procedure time for mucosal defect closure was 14 min, and the median number of clips used per patient was 12. No delayed adverse events were observed. The underwater clip closure method is a feasible option for complete closure of mucosal defects, regardless of the size or location of a duodenal endoscopic submucosal dissection.

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Clinical course and management of adverse events after endoscopic resection of superficial duodenal epithelial tumors: Multicenter retrospective study

Cited by 4 publications

References 31 publications

Short- and long-term outcomes of endoscopic submucosal dissection and laparoscopic and endoscopic cooperative surgery for superficial non-ampullary duodenal epithelial tumors

Short- and long-term outcomes of endoscopic submucosal dissection and laparoscopic and endoscopic cooperative surgery for superficial non-ampullary duodenal epithelial tumors

How to manage adverse events after endoscopic resection of superficial duodenal epithelial tumors

Underwater clip closure method for mucosal defects after duodenal endoscopic submucosal dissection (with video)

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