Endoscopic diagnosis of superficial non‐ampullary duodenal epithelial tumors in Japan: Multicenter case series

Abstract

Background and Aim:To verify the current status in Japan on endoscopic diagnosis of superficial non-ampullary duodenal epithelial tumors (SNADET) by a multicenter case series through a questionnaire survey.Methods: Nine endoscopists and a surgeon responded to a questionnaire on endoscopic diagnosis of SNADET. The subjects of this survey were histologically confirmed SNADET that were endoscopically or surgically resected from 2007 to 2012. This survey collected data of 364 patients with 396 SNADET.Results: Of the 396 SNADET, 121 were histologically diagnosed as low-grade dysplasia (LGD), 112 as high-grade dysplasia (HGD), and 163 as superficial adenocarcinoma (SAC) including 153 mucosal carcinomas and 10 submucosal carcinomas. Total number of SNADET increased from 125 in the first half to 271 in the second half of the survey period. Compared to LGD, a significantly greater number of HGD or SAC was found in the tumors having a diameter >5 mm as well as solitary or predominantly red color. Preoperative endoscopic diagnosis indicated significantly higher sensitivity and accuracy and significantly lower specificity for HGD or SAC of final histology than preoperative biopsy. Ten submucosal carcinomas had 0-I or 0-IIa+IIc macroscopic-type tumors with red color.Conclusions: This multicenter case series study suggested that the number of resected SNADET is dramatically increasing in Japan. Tumor diameter >5 mm and red color seemed to be signs for tumors of HGD or SAC. Preoperative endoscopy may provide a more reliable diagnosis of final histology of HGD or SAC than preoperative biopsy. Further studies are warranted for establishing endoscopic features of submucosal carcinoma.

Endoscopic Submucosal Dissection and Endoscopic Mucosal Resection for Non-Ampullary Superficial Duodenal Tumor

“…Unfortunately, they often achieve fewer en bloc resections. Because the malignant potential of NASDTs is extremely difficult to define from the macroscopic preoperative diagnosis [10,11], in clinical practice now, the most reliable conclusive diagnosis is the total excisional biopsy using EMR or ESD. However, there were no precise detailed criteria for the selection of EMR and ESD according to the size or the location of the lesion.…”

Clinicopathological Features and Magnifying Chromoendoscopic Findings of Non-Ampullary Duodenal Epithelial Tumors

“…The prevalence of duodenal adenomas was reported to be <0.4% in subjects who underwent esophagogastroduodenoscopy [2]. However, recently it has been reported that the incidence of duodenal carcinoma has been increasing during the past 2 or 3 decades [3], presumably due to the widespread application of upper endoscopy.…”

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

“…Thus, the results of this study are useful for the identification of benign and malignant lesions in SNADTs (10). Furthermore, a multicenter study revealed that a significantly higher number of high-grade dysplasia or superficial adenocarcinomas compared with low-grade dysplasia were identified in tumors with a diameter >5 mm with solely or predominantly red coloration (9). According to the aforementioned categorical descriptions, the lesion in the present study was identified to possess a mixed type surface with an unclassified pattern vessel and may be a category 4/5 tumor.…”

“…However, owing to the limited number of SNADT cases, the additional advantages of magnifying endoscopy in early duodenal cancer remain unknown and additional studies are required. Furthermore, due to the thin wall of the bowel, unintended fibrosis induced by common biopsy may affect subsequent ER, and the diagnostic accuracy of enhanced endoscopy and biopsy has been identified to be similar (78 and 75%, respectively) (9,25). Therefore, in the present case report, the ESD procedure was performed to remove the lesion for pathological analysis instead of forcep biopsy.…”

“…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)(8)(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.…”