Endoscopic Mucosal Resection Performed Underwater for Nonampullary Duodenal Epithelial Tumor: Evaluation of Feasibility and Safety.

Goro Shibukawa,Yoshitsugu Yoshida,Atsushi Irisawa,Ryo Igarashi,Yusuke Takasaki,Ai Sato,Hiroshi Hojo,Shogo Yamamoto,Takumi Maki,Noriyuki Arakawa,Tsunehiko Ikeda,Akane Yamabe,Yoko Abe

doi:10.1155/2018/7490961

Goro Shibukawa, Yoshitsugu Yoshida + Show 11 more

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https://doi.org/10.1155/2018/7490961

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Abstract

Objectives Recently, opportunities to encounter superficial nonampullary duodenal epithelial tumor (SNADET) have increased. EMR and ESD are performed to treat SNADET. However, the rate of perforation is higher than that of other gastrointestinal lesions, regardless of which method is used. Underwater EMR (UW-EMR) is immersion treatment of SNADET, which has low risk of perforation and can remove lesions safely and completely. In the present study, we retrospectively investigated patients in whom UW-EMR was performed to evaluate the feasibility and safety of UW-EMR for the treatment of SNADET. Methods The primary endpoint was to evaluate the feasibility of UW-EMR for the treatment of SNADET, and secondary objective was to determine the operation's safety. Results There were 14 participants, with a total of 16 lesions, who underwent UW-EMR between August 2015 and December 2017. Histological heteromorphism revealed that seven patients had low-grade adenoma, seven had high-grade adenoma, and two had adenocarcinoma. En bloc resection was performed in 14 lesions. In two patients, nodular lesions were observed in the scar and biopsy confirmed recurrences. There were no serious adverse events including bleeding or perforation. Conclusions UW-EMR may be a safe and effective treatment method for SNADET, if its therapeutic indication is adequately considered.

Highlights

The incidence of all cancers of the small intestine, including superficial nonampullary duodenal epithelial tumor (SNADET), is remarkably lower than that of other gastrointestinal cancers, such as cancers of the stomach and large intestine [1]
Histological heteromorphism in the resected specimens revealed that seven patients had lowgrade adenoma, seven had high-grade adenoma, and two had adenocarcinoma
En bloc resection was performed in 14 lesions (87.5%), but the remaining two lesions (12.5%) showed a remnant after initial the Underwater Endoscopic mucosal resection (EMR) (UW-EMR), and we performed additional resection on the same day

Summary

Introduction

The incidence of all cancers of the small intestine, including superficial nonampullary duodenal epithelial tumor (SNADET), is remarkably lower than that of other gastrointestinal cancers, such as cancers of the stomach and large intestine [1]. The duodenum has more nonneoplastic lesions than other organs, and the incidence of malignancy among neoplastic lesions appears to be low. There has been a recent trend, starting in the 1970s, showing an increase in the incidence of malignancy among neoplastic lesions [2]. Duodenal cancer is often detected at an advanced stage; the 5-year survival rate is less than 30%, and the prognosis is regarded as the worst among all small intestinal cancers [3]. Opportunities to encounter duodenal tumors have increased because of the popularization of endoscopy for upper gastrointestinal tract screening. No definite guidelines have been established regarding the indication of endoscopic therapy for duodenal tumor and selection of treatment strategy because of the low frequency of the procedure being performed

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