Zhong Ren1, Sheng-Li Lin1, Ping-Hong Zhou2, Shi-Lun Cai1, Zhi-Peng Qi1, Jian Li1, Li-Qing Yao1. 1. Endoscopy Center, Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. 2. Endoscopy Center, Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. zhou.pinghong@zs-hospital.sh.cn.
Abstract
BACKGROUND: Standard treatment for nonampullary duodenal tumors has not yet been established. In case of tumors originated from the muscularis propria (MP) layer and adherent to the serosa layer, the lesions can not be completely removed by ESD. However, with the development of the endoscopic suture technique, endoscopic full-thickness resection (EFTR) of duodenal subepithelial lesions has become possible. METHODS: We retrospectively analyzed 32 patients with nonampullary duodenal subepithelial lesions who underwent EFTR between February 2012 and January 2017. The suturing method, complications that occurred during and after the operations, perioperative management, tumor characteristics, and pathological findings were analyzed in all patients. RESULTS: The complete resection rate was 100%; all patients successfully received EFTR except for one patient who required conversion to open surgery. Severe abdominal pain was observed after the operation in one patient who then received laparoscopic exploration, and the possibility of delayed perforation was considered. Another patient showed a decline in blood oxygen saturation (SO2) and was transferred to the intensive care unit (ICU) for further management. Delayed bleeding and fistula were not observed. All patients achieved complete remission. CONCLUSION: EFTR is a safe, minimally invasive treatment modality that ensures complete eradication of the duodenal subepithelial lesions.
BACKGROUND: Standard treatment for nonampullary duodenal tumors has not yet been established. In case of tumors originated from the muscularis propria (MP) layer and adherent to the serosa layer, the lesions can not be completely removed by ESD. However, with the development of the endoscopic suture technique, endoscopic full-thickness resection (EFTR) of duodenal subepithelial lesions has become possible. METHODS: We retrospectively analyzed 32 patients with nonampullary duodenal subepithelial lesions who underwent EFTR between February 2012 and January 2017. The suturing method, complications that occurred during and after the operations, perioperative management, tumor characteristics, and pathological findings were analyzed in all patients. RESULTS: The complete resection rate was 100%; all patients successfully received EFTR except for one patient who required conversion to open surgery. Severe abdominal pain was observed after the operation in one patient who then received laparoscopic exploration, and the possibility of delayed perforation was considered. Another patient showed a decline in blood oxygen saturation (SO2) and was transferred to the intensive care unit (ICU) for further management. Delayed bleeding and fistula were not observed. All patients achieved complete remission. CONCLUSION: EFTR is a safe, minimally invasive treatment modality that ensures complete eradication of the duodenal subepithelial lesions.
Authors: Antonino Granata; Alberto Martino; Francesco Paolo Zito; Dario Ligresti; Michele Amata; Giovanni Lombardi; Mario Traina Journal: World J Gastrointest Endosc Date: 2022-02-16