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

Kuroki, Kazutaka; Sanomura, Yoji; Oka, Shiro; Yorita, Naoki; Kurihara, Mio; Mizumoto, Takeshi; Yoshifuku, Yoshikazu; Arihiro, Koji; Tanaka, Shinji; Chayama, Kazuaki

doi:10.1055/a-0998-3708

Cited by 14 publications

(25 citation statements)

References 27 publications

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“…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] . Moreover, a recent multicenter retrospective study including more than 3000 cases undergoing duodenal endoscopic treatment in Japan reported high duodenal ESD en bloc resection rates regardless of the size, location, or presence of fibrosis of the lesion, whereas other endoscopic resection techniques including endocopic mucosal resection (EMR) and underwater EMR revealed inferior resectability, especially for lesions larger than 20 mm [23] .…”

Section: Indications For Esd and Cure Criteriamentioning

confidence: 57%

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: 57%

ESD for duodenal carcinoma

Kato¹,

Sasaki²,

Maehata³

et al. 2022

MIS

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“…The macroscopic presentation for sporadic duodenal adenoma is mainly milk-white or reddish mucosa (▶ Fig. 1) [16,17], and the morphology of the lesion is usually 0-IIa in the Paris classification [17][18][19]. The associations between the macroscopic type or the tumor size and malignancy have been analyzed with conflicting results [1,13,20,21].…”

Section: Endoscopic Assessment Biopsy and Stagingmentioning

confidence: 99%

“…In more recent retrospective studies, high rates of complete endoscopic resection (90.5 %-96.1 %) have been obtained with EMR, whereas the adverse event rates ranged from 2 % to 24.4 % [17,19,[53][54][55][56][57][58][59][60][61]. Increasing lesion size was associated with reduced rates of en bloc resection as well as increased rate of adverse events [50,53,[55][56][57]62].…”

Section: Duodenal Emr In Management Of Large Adenomasmentioning

confidence: 99%

Endoscopic management of superficial nonampullary duodenal tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2021

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Main recommendations 1 ESGE recommends that all duodenal adenomas should be considered for endoscopic resection as progression to invasive carcinoma is highly likely.Strong recommendation, low quality evidence. 2 ESGE recommends performance of a colonoscopy, if that has not yet been done, in cases of duodenal adenoma.Strong recommendation, low quality evidence. 3 ESGE recommends the use of the cap-assisted method when the location of the minor and/or major papilla and their relationship to a duodenal adenoma is not clearly established during forward-viewing endoscopy.Strong recommendation, moderate quality evidence. 4 ESGE recommends the routine use of a side-viewing endoscope when a laterally spreading adenoma with extension to the minor and/or major papilla is suspected.Strong recommendation, low quality evidence. 5 ESGE suggests cold snare polypectomy for small (< 6 mm in size) nonmalignant duodenal adenomas.Weak recommendation, low quality evidence. 6 ESGE recommends endoscopic mucosal resection (EMR) as the first-line endoscopic resection technique for nonmalignant large nonampullary duodenal adenomas.Strong recommendation, moderate quality evidence. 7 ESGE recommends that endoscopic submucosal dissection (ESD) for duodenal adenomas is an effective resection technique only in expert hands.Strong recommendation, low quality evidence. 8 ESGE recommends using techniques that minimize adverse events such as immediate or delayed bleeding or perforation. These may include piecemeal resection, defect closure techniques, noncontact hemostasis, and other emerging techniques, and these should be considered on a case-by-case basis.Strong recommendation, low quality evidence. 9 ESGE recommends endoscopic surveillance 3 months after the index treatment. In cases of no recurrence, a further follow-up endoscopy should be done 1 year later. Thereafter, surveillance intervals should be adapted to the lesion site, en bloc resection status, and initial histological result. Strong recommendation, low quality evidence.

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“…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%

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

Cited by 14 publications

References 27 publications

ESD for duodenal carcinoma

ESD for duodenal carcinoma

Endoscopic management of superficial nonampullary duodenal tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Endoscopic resection of superficial non‐ampullary duodenal epithelial tumor

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