Present Status of Endoscopic Submucosal Dissection for Non-Ampullary Duodenal Epithelial Tumors

Abstract

Prediction of histology by endoscopic examination is important in the clinical management of non-ampullary duodenal epithelial tumors (NADETs), including adenoma and adenocarcinoma. The use of a simple scoring system based on the findings of white-light endoscopy or magnified endoscopy with narrow-band imaging is useful to differentiate between Vienna category 3 (C3) and C4/5 lesions. Less invasive endoscopic resection procedures, such as cold snare polypectomy, are quick to perform and convenient for small (<10 mm) C3 lesions. Neoplasms with higher grade histology, such as C4/5 lesions, should be treated by endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), or surgery. Although EMR often requires piecemeal resection, the complication rate is acceptable. Excellent complete resection rates could be achieved by ESD; however, it remains a challenging method considering the high risk of complications. Shielding or closure of the ulcer after ESD is effective at decreasing the risk of delayed bleeding and perforation. Laparoscopic endoscopic cooperative surgery is an ideal treatment with a high rate of en bloc resection and a low rate of complications, although it is limited to high-volume centers. Patients with NADETs could benefit from a multidisciplinary approach to stratify the optimal treatment based on endoscopic diagnoses. Clin Endosc 2020 Jan 15.

The incidence of non‐ampullary duodenal cancer in Japan: The first analysis of a national cancer registry

“…Furthermore, most patients with duodenal cancer are diagnosed at an advanced stage, resulting in a poor prognosis 5–7 . With advances in endoscopic equipment and increasing awareness of duodenal tumors, attention to this field has been increasing worldwide 8–12 . The number of patients with duodenal cancer has been gradually increasing 6,13 .…”

How to Choose the Best Procedure Type for Duodenal Neuroendocrine Tumors With a Maximum Diameter of 1 to 2 Cm a Propensity Score Matching Analysis Based on the SEER Database

“…Endoscopic treatment, as the main treatment method for tumors less than 1 cm, has the signi cant advantages of short operation time, low cost, short hospital stay, and less impact on quality of life [9].…”

“…However, due to the thin wall of the duodenum and its rich blood vessels, most tumors invade the submucosa. Therefore, duodenal endoscopic submucosal dissection is truly challenging, and even Japanese experts think twice before indicating [11], because there are risks of bleeding, perforation, positive margins, and missed metastatic lymph nodes in endoscopic resection treatment [8,9,[12][13][14][15][16]. Some studies reported that the lymphatic metastasis rate of d-NET with a tumor of 1-2 cm in diameter was approximately 60% [17,18].…”

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