Predictors of technical difficulty with duodenal ESD

Abstract

Background and study aims Duodenal endoscopic submucosal dissection (ESD) is still considered technically challenging; however, few studies have objectively analyzed predictors of the technical difficulty. Therefore, the aim of the current study was to elucidate predictors of the technical difficulty of duodenal ESD. Patients and methods This was a retrospective observational study. From June 2010 to June 2017, a total of 174 consecutive patients with superficial duodenal epithelial neoplasia who underwent ESD were included in this study. We tried to identify predictors for technical difficulty of ESD by defining technical difficulty as either procedure time > 100 minutes or intraprocedural perforation. Moreover, we constructed a scoring system consisting of factors that were significant in the multivariate analysis. Results The proportion of patients with technical difficulty was 34.5 %. In the multivariate analysis, lesion location in flexural part [odds ratio (OR), 2.61; 95 % confidence interval (CI), 1.02 – 6.68], larger lesion size (> 40 mm) (OR, 5.26; 95% CI, 2.15 – 12.9), and occupied circumference > 50 % of the duodenum (OR, 5.80; 95 % CI, 1.83 – 18.4) were associated with technical difficulty. Conclusion A lesion location in flexural part, lesion size >40 mm and occupied circumference > 50 % were risk factors for technical difficulty of duodenal ESD.

Establishment of an in‐vivo porcine delayed perforation model after duodenal endoscopic submucosal dissection

“…Complications such as perforation are seen at a higher rate with duodenal ESD than in gastric or colonic ESD 2–5 . Although the efficacy of animal gastric, esophageal, and colonic ESD training models has been reported, few studies have examined the efficacy of animal duodenal ESD models 14–16 .…”

“…Endoscopic submucosal dissection (ESD) enables an en bloc treatment of relatively large tumors and can be applied to SNADETs. However, a high rate of intraoperative and postoperative perforation occurs with ESD for SNADETs, 2–4 which is possibly induced by ischemic changes or necrosis due to dissection of thin duodenal mucosa 5 . In addition, exposure to pancreatic juice and bile likely participates in delayed perforation 6 .…”

Endoscopic submucosal dissection using countertraction with clips and rubber band allows safe en bloc resection of recurrent duodenal superficial lesions with intense fibrosis

“…EMR is safe but can lead to a 20 % -30 % recurrence rate because of piecemeal resections. Conversely, duodenal ESD has a high rate of en bloc resection but is technically challenging and has ≤ 50 % risk of complications (bleeding and perforation) [1,2]. We present the case of a 60-year-old patient with multiple sporadic duodenal adenomas.…”

Successful duodenal endoscopic submucosal dissection using multiple clip-and-thread traction for a large tumor located in the duodenal bulb

“… 1 , 2 , 3 , 4 Duodenal ESD is technically challenging; large tumor size and poor endoscopic maneuverability particularly contribute to technical difficulties and intraoperative perforation. 5 Herein, we report a technically difficult duodenal ESD that was performed successfully within a short time using multiple clip-and-thread traction. Written informed consent was obtained from the patient after the risks and benefits of the treatment had been fully explained before the dissection.…”