Value of endoscopic submucosal dissection for duodenal lesions in 78 patients

Abstract

To assess the clinical value of endoscopic submucosal dissection(ESD) for duodenal lesion. A total of 78 patients with duodenal lesion were treated with ESD from November 2006 to August 2010. The clinical data were retrospectively analyzed. There were 46 male and 14 female patients. The mean age was(54±9) years. The lesion location included the duodenal bulb(n=39, 50%), the junction of bulb and descending part(n=19, 24.4%), and the descending part(n=20, 25.8%). The mean diameter of the lesions was(2.1±1.7) cm. Fifty-one(65.4%) lesions originated from the mucosa, including inflammatory/ hyperplastic polyps(n=22, 28.2%), villous/tubular adenoma(n=26, 33.3%), and hamartomas polyps(n=3, 3.8%). Twenty-five(32.1%) lesions originated from the submucosa, including Brunner's glands adenoma(n=15, 19.2%), ectopic pancreas(n=3, 3.8%), carcinoid tumor(n=3, 3.8%), lipoma(n=2, 2.6%), myxoinoma(n=1, 1.3%), and angio-lymphangioma(n=1, 1.3%). There were two lesions originated from the muscularis propria(n=2, 2.5%), and both were ectopic pancreas. All cases received ESD successfully. The mean operative time was(37±41) min and the mean blood loss was(23±15) ml. The perioperative complication rate was 35.9%(28/78), including intraoperative perforation(n=6), delayed perforation(n=3), intraoperative hemorrhage(n=10), delayed bleeding(n=7), and transient elevation of serum amylase(n=2). Postoperative pathological examination showed vascular invasion with tumor cells in one patient, who received extended resection later. The remaining 77 patients showed no recurrence during the followed up(rang, 3-23 months) using endoscopy. ESD is an effective, safe, minimally invasive method for the management of duodenal lesions.