Delayed perforation: A hazardous complication of endoscopic resection for non‐ampullary duodenal neoplasm

Inoue, Takuya; Uedo, Noriya; Yamashina, Takeshi; Yamamoto, Sachiko; Hanaoka, Noboru; Takeuchi, Yoji; Higashino, Koji; Ishihara, Ryu; Iishi, Hiroyasu; Tatsuta, Masaharu; Takahashi, Hidenori; Eguchi, Hidetoshi; Ohigashi, Hajime

doi:10.1111/den.12104

Cited by 162 publications

(206 citation statements)

References 32 publications

(75 reference statements)

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“…Previous studies have demonstrated that if the perforation is in the course of the surgery, the hole maybe closed using an endoscopic titanium clip or sutured using anylon snare, followed by the administration of antibiotics and fasting for several days (8,(34)(35)(36)(37). Abdominal computed tomography may be performed in all patients with perforation to identify whether the retroperitoneal perforation has occurred.…”

Section: Discussionmentioning

confidence: 99%

An early superficial non-ampullary duodenal tumor cured with endoscopic submucosal dissection: A case report

Lin

Yang

et al. 2017

Oncology Letters

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Abstract. Early superficial non-ampullary duodenal tumors are particularly rare, the clinical manifestations, including typical endoscopic or imaging features, and treatment methods are not well-characterized. The present case report describes a case of an asymptomatic 74-year-old male who presented to the Taizhou People's Hospital (Taizhou, China) for a regular health screening, where a primary superficial non-ampullary duodenal tumor was identified. Upper endoscopy revealed ~1.2 cm lesion in the second portion of the duodenum. Chromoscopy and magnification endoscopy indicated an early cancer characteristic. Subsequent endoscopic submucosal dissection was performed to remove the lesion. Histopathology validated that the lesion was a high-grade intro-epithelial neoplasm without lymph node or blood vessel invasion. IntroductionSuperficial non-ampullary duodenal tumor (SNADT), adenoma or carcinoma, is a rare type of gastrointestinal tract epithelial tumor and can be defined as a lesion limited to the mucosa, and/or submucosa which is not arising from the papilla of Vater (1,2). Typically, the likelihood of developing duodenal adenoma in patients with familial adenomatous polyposis (FAP) is high and this type of adenoma may progress to carcinoma (3). In contrast, sporadic NADT may develop de novo or through the adenoma-carcinoma pathway, as observed in patients with FAP (4). The prognosis of patients with advanced stage carcinoma is poor (5). However, if the duodenal tumor is diagnosed at an early stage and the patient undergoes complete resection, using an endoscopic method, the patient may experience a markedly improved outcome. Therefore, early detection and treatment of lesions are required (6).As the incidence of sporadic SNADT is rare, endoscopic markers suggestive of early stage SNADT have not been established. In addition, although endoscopic approaches, including endoscopic mucosa resection (EMR) and endoscopic submucosal dissection (ESD), are minimally invasive, and localized treatments in comparison to conventional surgery, there are a number of high risk complications (including bleeding and perforation) which may occur during the endoscopic resection (ER) (7-9). Therefore, the relatively rare incidence, and the presence of a thin duodenal wall and rich vascularity make it difficult to detect and treat SNADT lesions.The present case report describes an elderly patient presented to the Taizhou People's Hospital (Taizhou, China) for esophagogastroduodenoscopy and was identified to exhibit a superficial lesion (~1.2 cm) in the second portion of the duodenum. Chromoscopy and magnification endoscopy with narrow band imaging (ME-NBI) indicated an early stage lesion. Subsequently, ESD was performed to remove the lesion. Histopathology validated the high-grade intro-epithelial tumor diagnosis with negative margins, and without lymph or blood vessel involvement. Case reportIn the present case report, a 70-year-old Chinese male presented to the Taizhou People's Hospital (Taizhou, China) for a regular health scree...

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Section: Discussionmentioning

confidence: 99%

An early superficial non-ampullary duodenal tumor cured with endoscopic submucosal dissection: A case report

Lin

Yang

et al. 2017

Oncology Letters

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“…Bleeding was easily managed endoscopically using coagulation forceps, after which the patient was discharged. Large, flat adenomas in the small intestine are difficult to remove and are associated with a high risk of complications [3,4]. The present case is the first one in the literature describing the use of underwater EMR to remove a polyp in the ileum.…”

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confidence: 86%

Underwater endoscopic mucosal resection of a large depressed adenoma in the ileum

et al. 2014

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“…Although ESD has been presently performed for superficial nonampullary tumors in the duodenum (27), it is well noted that delayed perforation and bleeding occurs frequently after duodenal ESD (28,29). Moreover, this procedure cannot apply to periampullary tumors, because suturing of seromuscular layer cannot be performed near the pancreas.…”

Section: Gastrointestinal Cancersmentioning

confidence: 99%

Laparoscopic and endoscopic cooperative surgery for gastrointestinal tumor

Niimi¹,

Ishibashi²,

Mitsui³

et al. 2017

Ann. Transl. Med.

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With technological progress of endoscopic submucosal dissection (ESD) in the last decade, several laparoscopic and endoscopic cooperative surgeries (LECS) for gastrointestinal tumor have recently been developed.LECS is definitely favorable to the minimization of surgical margin, which leads to functional and anatomical preservation of gastrointestinal tract. LECS for gastrointestinal tumor is mainly sorted by two categories: exposure procedures and non-exposure procedures between endoluminal and extraluminal spaces. Exposure procedures have the potential risk of gastric contents or tumor cells spilling out over the abdominal cavity, because the stomach wall has to be perforated intentionally during the procedure. In order to avoid the potential these risks, nonexposure procedures have been developed. Currently, the LECS concept has rapidly permeated for treatment of gastrointestinal tumor due to its certainty and safety, although there is still room for improvement to lessen its technical difficulty. This review describes the current LECS for gastrointestinal tumor based on the several articles.

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Delayed perforation: A hazardous complication of endoscopic resection for non‐ampullary duodenal neoplasm

Abstract: Endoscopic resection for non-ampullary duodenal neoplasms has a possible risk of morbid complication i.e. delayed perforation, especially in patients with lesions located on the side distal from the ampulla and who are treated with piecemeal EMR or ESD.

Cited by 162 publications

References 32 publications

An early superficial non-ampullary duodenal tumor cured with endoscopic submucosal dissection: A case report

An early superficial non-ampullary duodenal tumor cured with endoscopic submucosal dissection: A case report

Underwater endoscopic mucosal resection of a large depressed adenoma in the ileum

Laparoscopic and endoscopic cooperative surgery for gastrointestinal tumor

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