Abstract
Background and aimsThe duodenum is considered a challenging area for the endoscopic resection of lesions. This study aimed to evaluate the efficacy and safety of over-the-scope clip (OTSC)-assisted endoscopic full-thickness resection (EFTR) for complex nonampullary duodenal lesions unsuitable for conventional resection techniques.Methods and patients We conducted a retrospective case review of 13 consecutive patients with complex nonampullary duodenal tumors that were unsuitable for conventional resection techniques; these patients underwent EFTR assisted with OTSC at Beijing Friendship Hospital, Capital Medical University from September 2015 to September 2020. The OTSC device was placed, and tumors were resected after the lesions were identified. Data were abstracted for demographics, lesion features, histopathologic diagnoses, technical success rates, complete resection (R0 resection) rates, and complications.ResultsThirteen patients with duodenal lesions (6 adenomas and 7 submucosal tumors with nonlifting signs, incomplete lifting signs, difficult locations, failed ESD/EMR attempts or suspected origin in the muscularis propria) subjected to EFTR were included. The sizes of all the lesions evaluated by endoscopy were smaller than 20 mm, and most of them (84.6%, 11/13) were smaller than 12 mm. All 13 applications of the clips, endoscopic resection and full-thickness resection were successful (13/13, 100%). Complete resection was achieved in 12 patients (12/13, 92.3%). There were no immediate or delayed complications, including bleeding, infection and perforation.ConclusionsOTSC -assisted EFTR appears to be effective and safe for complex nonampullary duodenal lesions smaller than 20 mm (particularly those ≤ 10–12 mm) that are unsuitable for conventional resection techniques.
Highlights
For duodenal tumors, traditional endoscopic treatment, such as endoscopic mucosal resection (EMR) and endoscopic submucosal resection (ESD), has not been carried out as smoothly as in the stomach, esophagus and colon because the anatomical structure of the duodenum has brought endoscopic treatment more difficulties and challenges, such as the narrow lumen andWei et al BMC Gastroenterology (2021) 21:476Brunner’s glands in the submucosa, which harden the duodenal wall and result in poor mucosal lifting
over-the-scope clip (OTSC)-assisted endoscopic full-thickness resection (EFTR) appears to be effective and safe for complex nonampullary duodenal lesions smaller than 20 mm that are unsuitable for conventional resection techniques
Exposed EFTR first adopts EFTR accompanied by artificial perforation and uses the Overstitch System (Apollo Endosurgery, Austin, USA) or the overthe-scope clip (OTSC) device (Ovesco Endoscopy, Tübingen, Germany) to close the wound, thereby posing the risk of exposure to abdominal cavity infection [4,5,6]
Summary
Traditional endoscopic treatment, such as endoscopic mucosal resection (EMR) and endoscopic submucosal resection (ESD), has not been carried out as smoothly as in the stomach, esophagus and colon because the anatomical structure of the duodenum has brought endoscopic treatment more difficulties and challenges, such as the narrow lumen andWei et al BMC Gastroenterology (2021) 21:476Brunner’s glands in the submucosa, which harden the duodenal wall and result in poor mucosal lifting. Research on endoscopic full-thickness resection (EFTR) allowing for definitive diagnosis and potential curative treatment of lesions involving any layer of the gastrointestinal wall has gradually increased, which may help solve this problem. The new full-thickness resection device (FTRD; Ovesco Endoscopy, Tübingen, Germany) system is designed in such a way that it allows complete and reliable closure of the gastrointestinal wall by applying an OTSC immediately before snare resection of the enclosed gut wall, which achieves a nonexposed EFTR, limited by oversize and poor flexibility in the upper gastrointestinal tract. The third EFTR method (assisted with OTSC) has good flexibility and convenient operation and seems more suitable for duodenal lesions. This study aimed to evaluate the efficacy and safety of over-the-scope clip (OTSC)-assisted endoscopic full-thickness resection (EFTR) for complex nonampullary duodenal lesions unsuitable for conventional resection techniques
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