Endoscopic Submucosal Dissection for Superficial Duodenal Neoplasms

Abstract

Endoscopic submucosal dissection (ESD) has emerged as a novel technique for achieving en bloc resection for superficial neoplasms limited to the mucosa. ESD was originally developed in Japan as a method of endoscopic resection of superficial gastric cancers. In our hospital, ESD has been used concurrently in other parts of the gastrointestinal tract, including the esophagus and colorectum from the beginning of its development. However, ESD in the duodenum is considered more challenging than other parts. From August 2005 to March 2008, a total of 15 superficial duodenal neoplastic lesions in 14 patients were treated with endoscopic resection. Of these, nine underwent ESD. We report our experience with duodenal ESD with a combination of ST hood and hook knife.

Commentary on Laparoscopic-Endoscopic Cooperative Surgery for Duodenal Lesions

“…Endoscopic submucosal dissection (ESD) of duodenal lesions is practically difficult and is occasionally accompanied by perforation of eroded luminal walls [6,7]. Laparoscopic wedge resection of the duodenum is indicated for quite limited cases such as small tumors or tumors with a small base.…”

Laparoscopic and endoscopic cooperative surgery for non-ampullary duodenal epithelial neoplasms

“…Exposure of the epithelial injury in the duodenum to bile and pancreatic juice impairs tissue regeneration [18,19] . Consequently, repair of the mucosal defect resulting from ESD is critical for the prevention of postoperative complications in LECS for NADENs.…”

Laparoscopy Assisted Transduodenal Resection of a Periampullary Tumor at the Inferior Duodenal Angulus

“…There appears to be an increased risk of perforation when ESD is performed for duodenal tumors [1,2]. In the small duodenal lumen, maneuvering endoscopically at 5 points near the tumor, and a surgical drain was placed in the main pancreatic duct via the ampulla of Vater (Figure 1c).…”

“…Endoscopic Submucosal Dissection (ESD) of duodenal lesions is difficult because of the thinness of the duodenal wall and the narrow working space [1,2]. In cases in which the tumor exists in the third or fourth portion of the duodenum, endoscopic removal is especially difficult and sometimes even impossible.…”