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Application of endoscopic submucosal dissection in duodenal space-occupying lesions

BACKGROUND: Endoscopic submucosal dissection (ESD) has been advocated by digestive endoscopists because of its comparable therapeutic effect to surgery, reduced trauma, faster recovery, and fewer complications. However, ESD for lesions of the duodenum is more challenging than those occurring at othe...

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Autores principales: Li, Xiao-Yu, Ji, Kai-Yue, Qu, Yu-Hu, Zheng, Juan-Juan, Guo, Ying-Jie, Zhang, Cui-Ping, Zhang, Kun-Peng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7760427/
https://www.ncbi.nlm.nih.gov/pubmed/33392310
http://dx.doi.org/10.12998/wjcc.v8.i24.6296
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author Li, Xiao-Yu
Ji, Kai-Yue
Qu, Yu-Hu
Zheng, Juan-Juan
Guo, Ying-Jie
Zhang, Cui-Ping
Zhang, Kun-Peng
author_facet Li, Xiao-Yu
Ji, Kai-Yue
Qu, Yu-Hu
Zheng, Juan-Juan
Guo, Ying-Jie
Zhang, Cui-Ping
Zhang, Kun-Peng
author_sort Li, Xiao-Yu
collection PubMed
description BACKGROUND: Endoscopic submucosal dissection (ESD) has been advocated by digestive endoscopists because of its comparable therapeutic effect to surgery, reduced trauma, faster recovery, and fewer complications. However, ESD for lesions of the duodenum is more challenging than those occurring at other levels of the gastrointestinal tract due to the thin intestinal wall of the duodenum, narrow intestinal space, rich peripheral blood flow, proximity to vital organs, and high risks of critical adverse events including intraoperative and delayed bleeding and perforation. Because of the low prevalence of the disease and the high risks of severe adverse events, successful ESD for lesions of the duodenum has rarely been reported in recent years. AIM: To investigate the efficacy and safety of ESD in the treatment of duodenal space-occupying lesions. METHODS: Clinical data of 24 cases of duodenal lesions treated by ESD at the Digestive Endoscopy Center of the Affiliated Hospital of Qingdao University from January 2016 to December 2019 were retrospectively analyzed. RESULTS: All of the 24 cases from 23 patients underwent ESD treatment for duodenal space-occupying lesions under general anesthesia, including 15 male and 8 female patients, with a mean age of 58.5 (32.0-74.0) years. There were 12 lesions (50%) in the duodenal bulb, 9 (37.5%) in the descending part, and 3 (12.5%) in the ball-descending junction. The mean diameter of the lesion was 12.75 (range, 11-22) mm. Thirteen lesions originated from the mucosa, of which 4 were low-grade intraepithelial neoplasia, 3 were hyperplastic polyps, 2 were chronic mucositis, 2 were adenomatous hyperplasia, 1 was high-grade intraepithelial neoplasia, and 1 was tubular adenoma. Eleven lesions were in the submucosa, including 5 neuroendocrine neoplasms, 2 cases of ectopic pancreas, 1 stromal tumor, 1 leiomyoma, 1 submucosal duodenal adenoma, and 1 case of submucosal lymph follicular hyperplasia. The intraoperative perforation rate was 20.8% (5/24), including 4 submucosal protuberant lesions and 1 depressed lesion. The mean length of hospital stay was 5.7 (range, 3-10) d, and the average follow-up time was 25.8 (range, 3.0–50.0) mo. No residual disease or recurrence was found in all patients, and no complications, such as infection and stenosis, were found during the follow-up period. CONCLUSION: ESD is safe and effective in the treatment of duodenal lesions; however, the endoscopists should pay more attention to the preoperative preparation, intraoperative skills, and postoperative treatment.
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spelling pubmed-77604272021-01-01 Application of endoscopic submucosal dissection in duodenal space-occupying lesions Li, Xiao-Yu Ji, Kai-Yue Qu, Yu-Hu Zheng, Juan-Juan Guo, Ying-Jie Zhang, Cui-Ping Zhang, Kun-Peng World J Clin Cases Observational Study BACKGROUND: Endoscopic submucosal dissection (ESD) has been advocated by digestive endoscopists because of its comparable therapeutic effect to surgery, reduced trauma, faster recovery, and fewer complications. However, ESD for lesions of the duodenum is more challenging than those occurring at other levels of the gastrointestinal tract due to the thin intestinal wall of the duodenum, narrow intestinal space, rich peripheral blood flow, proximity to vital organs, and high risks of critical adverse events including intraoperative and delayed bleeding and perforation. Because of the low prevalence of the disease and the high risks of severe adverse events, successful ESD for lesions of the duodenum has rarely been reported in recent years. AIM: To investigate the efficacy and safety of ESD in the treatment of duodenal space-occupying lesions. METHODS: Clinical data of 24 cases of duodenal lesions treated by ESD at the Digestive Endoscopy Center of the Affiliated Hospital of Qingdao University from January 2016 to December 2019 were retrospectively analyzed. RESULTS: All of the 24 cases from 23 patients underwent ESD treatment for duodenal space-occupying lesions under general anesthesia, including 15 male and 8 female patients, with a mean age of 58.5 (32.0-74.0) years. There were 12 lesions (50%) in the duodenal bulb, 9 (37.5%) in the descending part, and 3 (12.5%) in the ball-descending junction. The mean diameter of the lesion was 12.75 (range, 11-22) mm. Thirteen lesions originated from the mucosa, of which 4 were low-grade intraepithelial neoplasia, 3 were hyperplastic polyps, 2 were chronic mucositis, 2 were adenomatous hyperplasia, 1 was high-grade intraepithelial neoplasia, and 1 was tubular adenoma. Eleven lesions were in the submucosa, including 5 neuroendocrine neoplasms, 2 cases of ectopic pancreas, 1 stromal tumor, 1 leiomyoma, 1 submucosal duodenal adenoma, and 1 case of submucosal lymph follicular hyperplasia. The intraoperative perforation rate was 20.8% (5/24), including 4 submucosal protuberant lesions and 1 depressed lesion. The mean length of hospital stay was 5.7 (range, 3-10) d, and the average follow-up time was 25.8 (range, 3.0–50.0) mo. No residual disease or recurrence was found in all patients, and no complications, such as infection and stenosis, were found during the follow-up period. CONCLUSION: ESD is safe and effective in the treatment of duodenal lesions; however, the endoscopists should pay more attention to the preoperative preparation, intraoperative skills, and postoperative treatment. Baishideng Publishing Group Inc 2020-12-26 2020-12-26 /pmc/articles/PMC7760427/ /pubmed/33392310 http://dx.doi.org/10.12998/wjcc.v8.i24.6296 Text en ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
spellingShingle Observational Study
Li, Xiao-Yu
Ji, Kai-Yue
Qu, Yu-Hu
Zheng, Juan-Juan
Guo, Ying-Jie
Zhang, Cui-Ping
Zhang, Kun-Peng
Application of endoscopic submucosal dissection in duodenal space-occupying lesions
title Application of endoscopic submucosal dissection in duodenal space-occupying lesions
title_full Application of endoscopic submucosal dissection in duodenal space-occupying lesions
title_fullStr Application of endoscopic submucosal dissection in duodenal space-occupying lesions
title_full_unstemmed Application of endoscopic submucosal dissection in duodenal space-occupying lesions
title_short Application of endoscopic submucosal dissection in duodenal space-occupying lesions
title_sort application of endoscopic submucosal dissection in duodenal space-occupying lesions
topic Observational Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7760427/
https://www.ncbi.nlm.nih.gov/pubmed/33392310
http://dx.doi.org/10.12998/wjcc.v8.i24.6296
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