Endoscopic submucosal dissection for nonampullary large superficial adenocarcinoma/adenoma of the duodenum: feasibility and long-term outcomes

Abstract

Background and study aims: The clinical benefit of endoscopic submucosal dissection (ESD) for superficial duodenal neoplasias has not yet been verified. The aims of this study were to validate the feasibility and long-term outcomes of ESD for nonampullary superficial duodenal neoplasias, larger than 20 mm. Patients and methods: 41 patients, with 41 nonampullary large superficial duodenal neoplasias, who underwent ESD between April 2005 to March 2013 were included in the study. The short- and long-term outcomes were retrospectively evaluated, related to tumor size, resection size, histological type, invasion depth, complete resection rate, operation time, perforation rate, delayed bleeding rate, local recurrence rate, distant metastasis, and survival rate. Results: ESD was successfully completed in 38 of 41 patients (92.7 %). The median sizes of tumors and resected specimens were, respectively, 26 mm (range 20 – 70 mm) and 36.5 mm (range 23 – 80 mm). Histopathological findings showed 13 adenocarcinomas (12 mucosal, 1 submucosal) and 28 adenomas (26 high grade dysplasia, 2 low grade dysplasia). The complete resection rate was 89.5 % (34 /38 tumors). The mean operation time was 128.3minutes. Perforation during ESD occurred in 39 % and delayed bleeding occurred in 18.4 %. The median observation period was 48 months (range 3.2 – 94.1 months), and no local recurrence or distant metastasis was seen during this time, representing a disease-free survival rate of 100 %. Conclusions: ESD for nonampullary large superficial duodenal adenocarcinoma/adenoma is feasible with favorable long-term outcomes. However, because of the high complication rate due to its technical difficulty, experience and skill of the operator, along with adequate perioperative management, are essential.

Diagnostic algorithm of magnifying endoscopy with narrow band imaging for superficial non‐ampullary duodenal epithelial tumors

“…Operators determined the indication for EMR or ESD in a comprehensive manner based on the size and location of the lesion and the operability of endoscopy. Details of the EMR and ESD procedures are described elsewhere . Briefly, the lesion was elevated by a local injection of glyceol (Chugai Pharmaceutical Co., Tokyo, Japan) or hyaluronic acid.…”

“…Surgical treatment for non‐ampullary duodenal tumor can be invasive, especially because pancreaticoduodenectomy is done in advanced cases. Compared with gastric, esophageal, and colorectal cases, endoscopic treatment for superficial non‐ampullary duodenal epithelial tumors (SNADET), even those in the early stage, is associated with a high risk of complications, some of them serious, and demonstrates the hazardous nature of endoscopic treatment for SNADET …”

“…Compared with gastric, esophageal, and colorectal cases, endoscopic treatment for superficial non-ampullary duodenal epithelial tumors (SNADET), even those in the early stage, is associated with a high risk of complications, some of them serious, and demonstrates the hazardous nature of endoscopic treatment for SNADET. 1 Against this background, individual lesions should be treated according to their pathology, and endoscopic diagnosis is essential for determining a proper treatment strategy. Although many studies have investigated the utility of magnifying endoscopy with narrow band imaging (ME-NBI) for early esophageal, 2-5 gastric, 6,7 and colorectal 8 cancers, only a few ME-NBI studies have been done on SNADET.…”

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

“…ESD is recognized as a promising minimally invasive approach, which is curative and safe, even for large lesions in the stomach, esophagus, and colon (27)(28)(29). In contrast, performing ESD in the duodenum is technically challenging, due to the distinct anatomical characteristics of the duodenum, and has not been accepted as a radical method of local resection until the present moment (30). There have been a limited number of studies on the use of ESD to treat of SNADTs; however, a complete resection rate between 80 and 100% with no recurrence was revealed (17,31).…”

Feasibility of a Newly Developed Thumb Control Device for Simultaneous Manipulation of the Endoscope and Treatment Devices in Endoscopic Submucosal Dissection: A Clinical Feasibility Study

“…ESD is indicated for superficial tumors at various sites in the gastrointestinal tract, not only the esophagus, stomach, and colon, but also the pharynx and duodenum [2][3][4][5][6] . Despite ESD having a high completion rate of resection at all of these sites, the procedure is associated with technical difficulties, a long procedure time, and a high complication rate compared to the conventional EMR [7,8] .…”