Treatment for superficial non-ampullary duodenal epithelial tumors

Kakushima, Naomi; Kanemoto, Hideyuki; Tanaka, Masaki; Takizawa, Kohei; Ono, Hiroyuki

doi:10.3748/wjg.v20.i35.12501

Cited by 94 publications

(99 citation statements)

References 75 publications

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“…Surgical treatment is recommended in cases of DA larger than 2 cm and in cases with the presence of severe dysplasia, suspicious carcinomatous infiltration, or when there is recurrence after complete endoscopic resection [37,38]. According to the recent management studies from 2017, ampullary DAs should be primarily treated with endoscopic papillectomy, except in cases with suspected areas of invasive malignancy, IDE larger than 1 cm or patient's preference [6].…”

Section: Resultsmentioning

confidence: 99%

“…The endoscopic approach to non-ampullary lesions by conventional polypectomy techniques include cold snare polypectomy (CSP) for small lesions (< 10 mm) and piecemeal endoscopic mucosal resection (EMR) for larger lesions [37,39]. Endoscopic submucosal dissection (ESD) is considered contraindicated in the duodenum due to high risk of delayed perforation estimated up to 30% [40,41].…”

Section: Resultsmentioning

confidence: 99%

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Assessment of Duodenal Adenomas and Strategies for Curative Therapy

Pavlovic-Markovic

Dragašević²,

Krstić

et al. 2019

Dig Dis

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Background: The increasing incidence of duodenal neoplasm has underlined different methods of resection depending on the clinical presentation, endoscopic features and histopathology. In this comprehensive review, we systematically describe the current knowledge concerning the diagnosis and management of duodenal adenomas (DAs) and discuss data considering all possible therapeutic approaches. Summary: Among a variety of duodenal lesions, including neuroendocrine tumors and gastrointestinal stromal tumors, DAs present precancerous lesions of the duodenal papilla or non-ampullary region necessitating removal. DAs can occur sporadically (SDA) as rare lesions or relatively common in polyposis syndromes. The endoscopic resections of DA are associated with an increased degree of complexity due to distinctive anatomical properties of the duodenal wall, luminal diameter and the presence of ampulla with pancreatic and biliary drainage. The endoscopic techniques including cold snare polypectomy (CSP), endoscopic mucosal resection (EMR), and argon plasma coagulation ablation are suggested to be less invasive than surgical treatment, associated with shorter hospital stay and lower cost. According to the current clinical practice, surgery has been accepted as standard therapeutic approach in familial adenomatous polyposis patients with severe polyposis or DA not amenable to endoscopic resection. Key Messages: The strategy for endoscopic resection of DAs depends on the lesion size, morphology, location, and histopathology findings. Small adenomas are most frequently diagnosed and removed by standard CSP techniques, while large laterally spreading lesions and ampullary adenoma are referred for EMR or endoscopic papillectomy respectively. Screening colonoscopy is indicated in patients with SDA. Additional studies for new endoscopic strategies and techniques for curative therapy of DAs are needed to refine future management decisions. Complete resection of DA is considered curative, but nevertheless, long-term endoscopic follow-up is still required to detect and treat any recurrent arising lesions.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Assessment of Duodenal Adenomas and Strategies for Curative Therapy

Pavlovic-Markovic

Dragašević²,

Krstić

et al. 2019

Dig Dis

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“…Some authors claim that early adeno carcinoma of the ampulla of Vater, with out invasion to submucosa, can be very selectively treated endoscopically [5,7]. Mandatory stag ing is required -abdo men CT and endoscopic ultrasonography (EUS) to exclude spread ing to the bile duct or pancreatic duct.…”

Section: Introductionmentioning

confidence: 99%

Surgical Treatment of Ampullary Adenocarcinoma – Single Center Experience and a Review of Literature

et al. 2018

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SummaryBackground: Adenocarcinomas of ampulla of the Vater are relatively uncommon tumors of the gastrointestinal tract. In premalignant lesions endoscopic treatment predominate. Accord ing to some authors even early adenocarcinomas (limited to mucosa) can be solved endo scopically. In malignant lesions affect ing deeper layers (includ ing submucosa) surgical ther apy is the most important. The article summarises the current view for a surgical treatment of ampullary adenocarcinomas and presents results concern ing our group of patients. Materials and Methods: In 2012-2016 a total number of 17 patients underwent resection for a tumor of ampulla of the Vater. Patients underwent standard staging, were presented before a mul tidisciplinary committee and referred to a surgical treatment. The main measured parameters were the type of surgical procedure, 30day morbidity and mortality, histopathologic result and subsequent oncologic treatment. The Leeds Pathology Protocol was used to evaluate the specimens after pancreaticoduodenectomy (PD). Results: PD (n = 9) was a more often perfor med procedure than the transduodenal surgical ampullectomy (TSA) (n = 8). TSA predomina ted in polymorbid patients. Histological results (n = 17) established adenoma with highgrade dysplasia in 4 patients, the dia gnosis of adenocarcinoma was set in 13 patients. Eight patients underwent adjuvant oncologic ther apy (2 had adjuvant chemother apy, 6 had combination of chemoradiother apy). Conclusion: Premalignant neoplasias of ampulla of the Vater can be mostly solved by endoscopy. If endoscopic resection is not possible surgical ther apy is indica ted. PD is preferred procedure in the dia gnosis of adenocarcinoma. In highrisk and polymorbid patients, with no suspicion for a metastatic lymph nodes, TSA can be considered. Endoscopic ultrasonography is the imag ing modality of choice for local stag ing of ampulla of the Vater and has important role in decid ing between endoscopic, local surgical excision (TSA) or radi cal resection (PD). Our results confirmed rightfulness to perform TSA especially in elderly or polymorbid patients, where in histopathologic specimens evaluation in TSA procedures early T stage and more favorable grad ing predominated.

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“…Recent advances in gastrointestinal endoscopic technology and diagnostic skills have led to increased occurrence of asymptomatic non-ampullary duodenal epithelial neoplasms (NADENs) in daily clinical practice [1][2][3] . Either endoscopic mucosal resection (EMR) or submucosal dissection (ESD) has occasionally been indicated in the treatment of NADENs, but the procedure remains technically challenging, given that expertise in both meticulous dissection and subsequent repair is required in the narrow lumen of the duodenum [2][3][4][5] .…”

Section: Introductionmentioning

confidence: 99%

“…Either endoscopic mucosal resection (EMR) or submucosal dissection (ESD) has occasionally been indicated in the treatment of NADENs, but the procedure remains technically challenging, given that expertise in both meticulous dissection and subsequent repair is required in the narrow lumen of the duodenum [2][3][4][5] . In addition, the prevention of bleeding and perforation during and after the procedure is pivotal, given that the incidence of these serious complications is relatively frequent in ESD for NADENs [4][5][6] .…”

Section: Introductionmentioning

confidence: 99%

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

Toma¹,

Haraguchi²,

Fujii³

et al. 2018

MIS

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Aim: We herein describe our initial experience of laparoscopic and endoscopic cooperative surgery (LECS) for nonampullary duodenal epithelial neoplasms (NADENs) and reveal its clinical significance.Methods: This study included 5 consecutive patients treated by LECS for NADENs between April 2015 and January 2016 in our hospital. For surgery, R0-resection of NADENs was accomplished by endoscopic submucosal dissection (ESD), and the mucosal defect resulting from ESD was subsequently repaired by laparoscopic seromuscular suture and endoscopic clipping. Clinical records were reviewed retrospectively.Results: LECS was accomplished in four patients. There was a case of open conversion due to the relatively large mucosal defect resulting from ESD. In the postoperative course, no serious complications, including intra-and postoperative bleeding and delayed perforation, were noted. The duodenal stenosis occurred in the case of open conversion but was treated by repeated endoscopic balloon dilatation. Of the five lesions of NADENs, there were three adenomas and two adenocarcinomas confined in the mucosa. To date, no tumor recurrence was observed during the postoperative course. Conclusion:LECS is a promising procedure of choice in the treatment of NADENs, facilitating early resumption of both food intake and full daily activity in the postoperative course.

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Treatment for superficial non-ampullary duodenal epithelial tumors

Cited by 94 publications

References 75 publications

Assessment of Duodenal Adenomas and Strategies for Curative Therapy

Assessment of Duodenal Adenomas and Strategies for Curative Therapy

Surgical Treatment of Ampullary Adenocarcinoma – Single Center Experience and a Review of Literature

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

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