Duodenal endoscopic full-thickness resection (with video)

Short- and long-term outcomes of endoscopic submucosal dissection for non-ampullary duodenal neuroendocrine tumors

“…EMR is associated with positive vertical margins, or a crush and burn effect on the resected specimen, which leads to difficulties in performing a precise pathological evaluation. Recently, endoscopic full-thickness resection (EFTR) with the full-thickness resection devise (FTRD; Ovesco Endoscopy, Tübingen, Germany) for duodenal tumors had been reported [31,32]. Bauder et al reported that complete resection rates were 80% in five subepithelial tumors treated by FTRD.…”

“…Therefore, duodenal ESD might be unacceptable in western countries. On the other hand, the efficacy of EFTR using an FTRD for duodenal superficial tumors has been reported [31,32]. Since the evidence of EFTR for duodenal NETs is still unclear, comparative studies of the efficacy and safety of ESD and EFTR are needed.…”

Endoscopic full‐thickness resection for gastrointestinal submucosal tumors

“…There are no published series of free‐hand EFTR of duodenal lesions because of the fear of difficulty in closing large defects in the duodenum and the worry of leaks and severe associated morbidity from duodenal perforations. Likely because of these concerns only laparoscopy‐assisted EFTR has been reported for duodenal carcinoids and device‐assisted EFTR with “pre‐closure prior to resection” . In an unpublished study from our center, a total of 33 patients with non‐ampullary duodenal SMT, Cai, et al (17 males: 16 females; mean age 53.6 ± 11.6 years) were included of which 22 (66.7%) were located in the duodenal bulb, eight (24.2%) were located at the junction of the duodenal bulb and descending duodenum, and three (9.1%) were located in the descending duodenum.…”

“…Likely because of these concerns only laparoscopy-assisted EFTR has been reported for duodenal carcinoids 60 and device-assisted EFTR with "pre-closure prior to resection". 61 In an unpublished study from our center, a total of 33 patients with non-ampullary duodenal SMT, Cai, et al (17 males: 16 females; mean age 53.6 AE 11.6 years) were included of which 22 (66.7%) were located in the duodenal bulb, eight (24.2%) were located at the junction of the duodenal bulb and descending duodenum, and three (9.1%) were located in the descending duodenum. Mean maximal cross-sectional diameter of the tumors was 1.4 AE 0.6 cm.…”

Colonoscopy adenoma detection rates: Room for cognitive load theory?

“…Endoscopic resection of submucosal tumors arising from the muscular layer is challenging and harbors a significant risk of adverse events. 9,10 Recently, endoscopic full-thickness resection by the use of an over-the-scope clip, and laparoscopic and endoscopic cooperative surgery by combining laparoscopic resection with ESD, have been devised as minimally invasive alternatives. 9,10 We therefore recommend full-layer resection, either endoscopically, or laparoscopically, or both, as appropriate management of a Heinrich type I gastric ectopic pancreas.…”