Preoperative endoscopic diagnosis of superficial non-ampullary duodenal epithelial tumors, including magnifying endoscopy

Abstract

Superficial non-ampullary duodenal epithelial tumor (SNADET) is defined as a sporadic tumor that is confined to the mucosa or submucosa that does not arise from Vater's papilla, and it includes adenoma and adenocarcinoma. Recent developments in endoscopic technology, such as high-resolution endoscopy and image-enhanced endoscopy, may increase the chances of detecting SNADET lesions. However, because SNADET is rare, little is known about its preoperative endoscopic diagnosis. The use of endoscopic resection for SNADET, which has no risk of metastasis, is increasing, but the incidence of complications, such as perforation, is significantly higher than in any other part of the digestive tract. A preoperative diagnosis is required to distinguish between lesions that should be followed up and those that require treatment. Retrospective studies have revealed certain endoscopic findings that suggest malignancy. In recent years, several new imaging modalities have been developed and explored for real-time diagnosis of these lesion types. Establishing an endoscopic diagnostic tool to differentiate between adenoma and adenocarcinoma in SNADET lesions is required to select the most appropriate treatment. This review describes the current state of knowledge about preoperative endoscopic diagnosis of SNADETs, such as duodenal adenoma and duodenal adenocarcinoma. Newer endoscopic techniques, including magnifying endoscopy, may help to guide these diagnostics, but their additional advantages remain unclear, and further studies are required to clarify these issues.

Clinicopathological characteristics of non‐ampullary duodenal tumors and their phenotypic classification

“…The accuracy of biopsy‐based diagnoses was found to be poor in cases of NADETs . In pre‐operative diagnoses, 15–56% of cancers were underestimated at biopsy due to sampling errors, when compared to resected specimens . Second, our results were not validated because this was a single‐center study that involved a single expert's evaluation.…”

“…22 In pre-operative diagnoses, 15-56% of cancers were underestimated at biopsy due to sampling errors, when compared to resected specimens. [23][24][25] Second, our results were not validated because this was a single-center study that involved a single expert's evaluation. The interobserver agreement would be poor in cases of duodenal neoplasms owing to insufficient diagnostic experience, especially in lowvolume centers.…”

Clinical outcomes of endoscopic resection for superficial non-ampullary duodenal tumors

“…Superficial non-ampullary duodenal epithelial tumors (SNA-DETs) are defined as sporadic adenoma and adenocarcinoma that are confined to the mucosa or submucosa that do not arise from the ampulla of Vater [1]. Because of the rarity of SNADETs [2], their etiology, prevalence, and risk factors remain unknown.…”

Current Status and Challenges of Endoscopic Treatments for Duodenal Tumors

“…In addition, they classified mucosal microvascular structures to have (1) a network pattern and (2) an intra-villous-structure irregular pattern and reported that the network pattern was notable in adenomas with high-grade dysplasia and intramucosal carcinoma, particularly in depressed types. However, the number of cases are limited in both retrospective studies, and an accurate modality for a differential diagnosis between adenomas and early-stage carcinoma by endoscopy has yet to be established [8]. Regarding the biopsy of SNADETs, Kinoshita et al [9] reported a sensitivity of 37.5%, specificity of 83.1%, and accuracy of 71.6%, which are far from sufficient levels.…”