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Safety of endoscopic resection for duodenal subepithelial lesions with wound closure using clips and an endoloop: an analysis of 68 cases

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Abstract

Background

Endoscopic removal of a duodenal lesion is still considered to be a challenging procedure that can be fraught with potentially serious complications, specifically perforation or delayed bleeding. This study was to assess the safety of endoscopic resection for duodenal subepithelial lesions (SELs) with wound closure using clips and an endoloop.

Methods

From October 2010 to July 2015, a total of 68 consecutive patients with duodenal SELs were treated with endoscopic resection with wound closure using clips and an endoloop. The main outcome measures considered were the incidence of complete resection, perioperative perforation, delayed perforation, delayed bleeding, residual lesions, and lesion recurrence.

Results

Complete resection was successfully achieved for all 68 patients. The median lesion size was 1.7 cm. The median procedure time was 62 min. The mean hospital stay was 5.5 days. During the procedure, five patients developed perioperative perforations (7.4 %) and no patients developed delayed bleeding, delayed perforation, or other serious complications. The five patients with perioperative perforations recovered after conservative treatment. The perioperative perforation rate was significantly higher for lesions originating in the muscularis propria layer (18.2 %) than in the submucosal layer (2.2 %; p < 0.05). No residual or recurrent lesions were detected during the follow-up period (median: 27 months).

Conclusions

Endoscopic resection with wound closure using clips and an endoloop is an effective and reasonably safe therapeutic method for treating/removing duodenal SELs when managed by an experienced endoscopic team, and it can provide an alternative treatment option for patients with duodenal SELs.

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References

  1. Matsumoto S, Miyatani H, Yoshida Y (2013) Endoscopic submucosal dissection for duodenal tumors: a single-center experience. Endoscopy 45:136–137

    Article  CAS  PubMed  Google Scholar 

  2. Musumba C, Sonson R, Tutticci N, Nanda K, Bourke MJ (2014) Endoscopic submucosal dissection of a duodenal neuroendocrine tumor. Gastrointest Endosc 79:716

    Article  PubMed  Google Scholar 

  3. Xu GQ, Wu YQ, Wang LJ, Chen HT (2008) Values of endoscopic ultrasonography for diagnosis and treatment of duodenal protruding lesions. J Zhejiang Univ Sci B 9:329–334

    Article  PubMed  PubMed Central  Google Scholar 

  4. Chung JC, Chu CW, Cho GS, Shin EJ, Lim CW, Kim HC, Song OP (2010) Management and outcome of gastrointestinal stromal tumors of the duodenum. J Gastrointest Surg Off J Soc Surg Aliment Tract 14:880–883

    Article  Google Scholar 

  5. Chok AY, Koh YX, Ow MY, Allen JC Jr, Goh BK (2014) A systematic review and meta-analysis comparing pancreaticoduodenectomy versus limited resection for duodenal gastrointestinal stromal tumors. Ann Surg Oncol 21:3429–3438

    Article  PubMed  Google Scholar 

  6. Demetri GD, von Mehren M, Antonescu CR, DeMatteo RP, Ganjoo KN, Maki RG, Pisters PW, Raut CP, Riedel RF, Schuetze S, Sundar HM, Trent JC, Wayne JD (2010) NCCN Task Force report: update on the management of patients with gastrointestinal stromal tumors. J Natl Compr Cancer Netw JNCCN 8(Suppl 2):S1–41

    CAS  PubMed  Google Scholar 

  7. Bialek A, Wiechowska-Kozlowska A, Pertkiewicz J, Polkowski M, Milkiewicz P, Karpinska K, Lawniczak M, Starzynska T (2012) Endoscopic submucosal dissection for treatment of gastric subepithelial tumors (with video). Gastrointest Endosc 75:276–286

    Article  PubMed  Google Scholar 

  8. Lee CK, Lee SH, Chung IK, Lee TH, Park SH, Kim EO, Chung MS, Cho HD, Kim SJ (2012) Endoscopic full-thickness resection of a gastric subepithelial tumor by using the submucosal tunnel technique with the patient under conscious sedation (with video). Gastrointest Endosc 75:457–459

    Article  PubMed  Google Scholar 

  9. Li QL, Yao LQ, Zhou PH, Xu MD, Chen SY, Zhong YS, Zhang YQ, Chen WF, Ma LL, Qin WZ (2012) Submucosal tumors of the esophagogastric junction originating from the muscularis propria layer: a large study of endoscopic submucosal dissection (with video). Gastrointest Endosc 75:1153–1158

    Article  PubMed  Google Scholar 

  10. Maruoka D, Arai M, Kishimoto T, Matsumura T, Inoue M, Nakagawa T, Watanabe Y, Katsuno T, Tsuyuguchi T, Imazeki F, Yokosuka O (2013) Clinical outcomes of endoscopic resection for nonampullary duodenal high-grade dysplasia and intramucosal carcinoma. Endoscopy 45:138–141

    Article  CAS  PubMed  Google Scholar 

  11. Honda T, Yamamoto H, Osawa H, Yoshizawa M, Nakano H, Sunada K, Hanatsuka K, Sugano K (2009) Endoscopic submucosal dissection for superficial duodenal neoplasms. Dig Endosc Off J Jpn Gastroenterol Endosc Soc 21:270–274

    Google Scholar 

  12. Seo JY, Hong SJ, Han JP, Jang HY, Myung YS, Kim C, Lee YN, Ko BM (2014) Usefulness and safety of endoscopic treatment for nonampullary duodenal adenoma and adenocarcinoma. J Gastroenterol Hepatol 29:1692–1698

    Article  PubMed  Google Scholar 

  13. Basford PJ, George R, Nixon E, Chaudhuri T, Mead R, Bhandari P (2014) Endoscopic resection of sporadic duodenal adenomas: comparison of endoscopic mucosal resection (EMR) with hybrid endoscopic submucosal dissection (ESD) techniques and the risks of late delayed bleeding. Surg Endosc 28:1594–1600

    Article  PubMed  Google Scholar 

  14. Nonaka S, Oda I, Tada K, Mori G, Sato Y, Abe S, Suzuki H, Yoshinaga S, Nakajima T, Matsuda T, Taniguchi H, Saito Y, Maetani I (2015) Clinical outcome of endoscopic resection for nonampullary duodenal tumors. Endoscopy 47:129–135

    Article  PubMed  Google Scholar 

  15. Schmidt A, Bauder M, Riecken B, von Renteln D, Muehleisen H, Caca K (2015) Endoscopic full-thickness resection of gastric subepithelial tumors: a single-center series. Endoscopy 47:154–158

    PubMed  Google Scholar 

  16. Matsumoto S, Miyatani H, Yoshida Y, Nokubi M (2011) Duodenal carcinoid tumors: 5 cases treated by endoscopic submucosal dissection. Gastrointest Endosc 74:1152–1156

    Article  PubMed  Google Scholar 

  17. Tsujii Y, Nishida T, Nishiyama O, Yamamoto K, Kawai N, Yamaguchi S, Yamada T, Yoshio T, Kitamura S, Nakamura T, Nishihara A, Ogiyama H, Nakahara M, Komori M, Kato M, Hayashi Y, Shinzaki S, Iijima H, Michida T, Tsujii M, Takehara T (2015) Clinical outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms: a multicenter retrospective cohort study. Endoscopy 47:775–783

  18. Lepilliez V, Chemaly M, Ponchon T, Napoleon B, Saurin JC (2008) Endoscopic resection of sporadic duodenal adenomas: an efficient technique with a substantial risk of delayed bleeding. Endoscopy 40:806–810

    Article  CAS  PubMed  Google Scholar 

  19. Bourke MJ (2013) Endoscopic resection in the duodenum: current limitations and future directions. Endoscopy 45:127–132

    Article  CAS  PubMed  Google Scholar 

  20. Matsumoto S, Yoshida Y (2014) Selection of appropriate endoscopic therapies for duodenal tumors: an open-label study, single-center experience. World J Gastroenterol WJG 20:8624–8630

    Article  PubMed  Google Scholar 

  21. Ye LP, Yu Z, Mao XL, Zhu LH, Zhou XB (2014) Endoscopic full-thickness resection with defect closure using clips and an endoloop for gastric subepithelial tumors arising from the muscularis propria. Surg Endosc 28:1978–1983

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported as a project of the Zhejiang Province Bureau of Health (2013KYA226).

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    Authors and Affiliations

    1. Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, 150 Ximen Street, Linhai, 317000, Zhejiang Province, China

      Li-Ping Ye, Xin-Li Mao, Yu Zhang, Ling-Yan Shen & Xian-Bin Zhou

    2. Department of Pathology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, 150 Ximen Street, Linhai, Zhejiang Province, China

      Hai-Hong Zheng

    3. Department of Medical Administration, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, China

      Lin-Hong Zhu

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    1. Li-Ping Ye
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    Correspondence to Yu Zhang.

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    Ye, Zhang, Mao, Zheng, Shen, Zhou, and Zhu have no conflict of interest or financial ties to disclose.

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    Li-Ping Ye and Xin-Li Mao have contributed equally to this work.

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    Ye, LP., Mao, XL., Zheng, HH. et al. Safety of endoscopic resection for duodenal subepithelial lesions with wound closure using clips and an endoloop: an analysis of 68 cases. Surg Endosc 31, 1070–1077 (2017). https://doi.org/10.1007/s00464-016-5065-9

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    • DOI: https://doi.org/10.1007/s00464-016-5065-9

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