Abstract
Background
Premalignant duodenal lesions such as adenomas are rare. Surgical resection has been the standard approach to the treatment of these lesions. Endoscopic resection of superficial premalignant or malignant lesions of the gastrointestinal tract is used with increasing frequency. This study aimed to evaluate the safety and efficacy of endoscopic resection of duodenal neoplasms.
Methods
Patients with nonampullary duodenal adenomas or duodenal adenocarcinomas without familial polyposis syndrome between August 2002 and February 2009 were retrospectively analyzed. Data including location and size, technique used for the endoscopic resection, complications, and follow-up evaluation of the lesions were reviewed.
Results
The study enrolled 24 patients with duodenal neoplasms. Of these patients, 23 had duodenal adenomas and 1 had an adenocarcinoma confined to the mucosa. The mean age of the patients was 57 years (range, 40–82). In terms of location, 12 lesions (50%, 12/24) were found in the second portion of the duodenum, and 11 (45.8%, 11/24) were found in the first portion. Tubular adenomas were the most common type (17/24, 70.8%). There were four cases of the villotubular type and three of the villous type. Conventional endoscopic mucosal resection (EMR) was performed for 19 patients, EMR with ligation (EMR-L) for 3 patients, and snare polypectomy for 2 patients. Complete resection was achieved for 87.5% (21/24) of the patients, and the recurrence rate was 8.3% (2/24). All the complications were intraprocedural bleeding (n = 7), with no occurrence of perforation or infection. During a median follow-up period of 6 months (range, 3–36 months), recurrence of the duodenal neoplasm was observed in two cases. There was no procedure-related mortality.
Conclusions
Endoscopic resection of duodenal neoplasms was safe and effective treatment. During the short-term follow-up evaluation, EMR showed outcomes and complications comparable with prior procedures, including adenocarcinomas confined to the mucosa.
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References
Galandiuk S, Hermann RE, Jagelman DG, Fazio VW, Sivak MV (1988) Villous tumors of the duodenum. Ann Surg 207:234–239
Miller JH, Gisvold JJ, Weiland LH, Mcllrath DC (1980) Upper gastrointestinal tract: villous tumors. AJR Am J Roentgenol 134:933–936
Bories E, Pesenti C, Monges G, Lelong B, Moutardier V, Delpero JR, Giovannini M (2006) Endoscopic mucosal resection for advanced sessile adenoma and early-stage colorectal adenocarcinoma. Endoscopy 38:231–235
Jameel JK, Pillinger SH, Moncur P, Tsai HH, Duthie GS (2006) Endoscopic mucosal resection (EMR) in the management of large colorectal polyps. Colorectal Dis 8:497–500
Apel D, Jakobs R, Spiethoff A, Rieman JF (2005) Follow-up after endoscopic snare resection of duodenal adenomas. Endoscopy 37:444–448
Ahmad NA, Kochman ML, Long WB, Furth EE, Ginsberg GG (2002) Efficacy, safety, and clinical outcome of endoscopic mucosal resection: a study of 101 cases. Gastrointest Endosc 3:390–396
Bjork KJ, Davis CJ, Nagorney DM, Mucha P Jr (1990) Duodenal villous tumors. Arch Surg 125:961–965
Motton G, Veraldi GF, Fracastoro G, Ricci F, Laterza E, Dorrucci V, Cordiano C (1996) Vater’s papilla and periampullary area villous adenoma: personal experience about nine cases and review of the literature. Hepatogastroenterology 43:448–455
Chappius CW, Di Vincenti FC, Cohn I Jr (1989) Villous tumors of the duodenum. Ann Surg 209:593–599
Krukowski ZH, Ewen SW, Davidson AI, Matheson NA (1988) Operative management of tubulovillous neoplasms of the duodenum and ampulla. Br J Surg 75:150–153
Perez A, Saltzman JR, Carr-Locke DL, Brooks DC, Osteen RT, Zinner MJ, Ashley SW, Whang EE (2003) Benign nonampullary duodenal neoplasms. J Gastrointest Surg 7:536–541
Perzin KH, Bridge MF (1981) Adenomas of the small intestine: a clinicopathologic review of 51 cases and a study of their relationship to carcinoma. Cancer 48:799–819
Farnell MB, Sakorafas GH, Sarr MG, Rowland CM, Tsiotos GG, Farley DR, Nagorney DM (2000) Villous tumors of the duodenum: reappraisal of local vs. extended resection. J Gastrointest Surg 4:13–23
Lepilliez V, Chemaly M, Ponchon T, Napoleon B, Saurin JC (2008) Endoscopic resection of sporadic duodenal adenoma: an efficient technique with a substantial risk of delayed bleeding. Endoscopy 40:806–810
Disclosures
Jong Won Sohn, Seong Woo Jeon, Chang Min Cho, Min Kyu Jung, Sung Kook Kim, Dong Seok Lee, Hyuk Su Son, and In Kwon Chung have no conflicts of interest or financial ties to disclosure.
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Sohn, J.W., Jeon, S.W., Cho, C.M. et al. Endoscopic resection of duodenal neoplasms: a single-center study. Surg Endosc 24, 3195–3200 (2010). https://doi.org/10.1007/s00464-010-1114-y
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DOI: https://doi.org/10.1007/s00464-010-1114-y