Duodenal endoscopic submucosal dissection: Is it ready for primetime? (with video)

Endoscopic Submucosal Dissection for Large Duodenal Laterally Spreading Lesions is Feasible: A Multi-Center Retrospective Study

BACKGROUND AND AIMS

This retrospective study aimed to evaluate the effect and safety of endoscopic submucosal dissection (ESD) for large laterally spreading lesions located in the descending duodenum based on multi-center experiences.

METHODS

This multicentric retrospective study included 3 hospitals in China. Fifty-one patients with laterally spreading lesions of the duodenum who underwent ESD between February 2019 and December 2020 were enrolled. The en bloc resection rates, en bloc R0 resection rates, complication rates, and local recurrence after ESD were evaluated.

RESULTS

Of the 51 patients, the median age was 62 years old (ranging from 37 to 76 years old); among them, 29 were male and 22 were female. The average lesion size was 2.3 cm (ranging from 1.5 to 4.0 cm). All 51 lesions achieved en bloc R0 resection successfully, with the procedure time ranging from 20 to 117 min (median: 45.5 min). The hospital length of stay ranged from 4 to 90 days (median: 8.0 d). Two patients experienced delayed bleeding 3 days after ESD and 2 other patients were diagnosed with delayed perforation. Tumor residual and local recurrence did not occur during a short follow-up period.

CONCLUSIONS

ESD for laterally spreading lesions of the descending duodenum is feasible.

Rare resected eight cases of duodenal adenocarcinomas

INTRODUCTION

Duodenal adenocarcinoma is a rare malignancy; recently, it has been found to be accompanied by operative indications.

METHODS

Nine consecutive rare cases were diagnosed with duodenal carcinoma (DC), in which clinicopathological characteristics were retrospectively examined. Age was ranged over middle-aged males and females. No clinical onset with severe symptoms was observed, and the specific treatment for accompanied diseases or habits was not found.

OUTCOMES

One case of two T1 stage DCs that underwent pancreas-sparing duodenectomy. Stage II DC was diagnosed in three cases, and stage III DC was diagnosed in four cases. Pancreaticoduodenectomy (PD) mainly occurred in seven patients, and duodenectomy was limited in two patients. All operations were safely performed, and the postoperative course showed no severe morbidity. Histological findings showed R0 resection in eight cases and R1 at the retroperitoneal dissecting part in one case. Five patients with advanced-stage DC underwent adjuvant chemotherapy; however, four patients showed tumor recurrence within 12 months. With additional strong chemotherapy, eight patients survived up to 84 months, and one died of liver metastasis at 43 months after surgery. Three representative cases of mucosal invasion with widespread pancreas-sparing duodenectomy and advanced-stage DC cases undergoing duodenectomy or PD are shown.

CONCLUSION

In the field of upper digestive tract surgery, duodenal adenocarcinoma and various applications of surgery or adjuvant chemotherapy for long-term survival are important.