Year 2022 / Volume 114 / Number 6
Original
Endoscopic resection in combination with ligation for the treatment of duodenal subepithelial lesions: a single-center experience

343-347

DOI: 10.17235/reed.2021.8105/2021

De-feng Li, Rui-yue Shi, Feng Xiong, Hai-yang Zhang, Ting-ting Liu, Yan-hui Tian, Zheng-lei Xu, Ben-hua Wu, Ding-guo Zhang, Jun Yao, Li-sheng Wang,

Abstract
Introduction and aim: duodenal subepithelial lesions (SELs) are increasingly detected during endoscopic examinations. However, no feasible and safe methods are available to remove duodenal SELs. The present study aimed to assess the feasibility and safety of endoscopic resection in combination with ligation (ER-L) for the removal of duodenal SELs. Patients and methods: a total of 101 patients with duodenal SELs underwent ER-L from February 2010 to February 2020. The primary outcomes were complete resection, en bloc resection and R0 resection. The secondary outcomes included procedure duration, bleeding, perforation and residual lesions. A total of 101 patients with 101 duodenal SELs (ranged from 8.4 mm to 20.2 mm in size) were included in the study. Results: most of the SELs (95.1 %) originated from the submucosal layer and were successfully removed using ER-L. The rates of complete resection, en bloc resection and R0 resection were 100 %, 96.0 % and 88.1 %, respectively. The median procedure duration was eight minutes. There were no severe complications, except for four patients who developed post-procedure bleeding (4.0 %) and recovered after conservative treatment. Furthermore, no residual lesions were detected during the follow-up period (median of 36 months). In fact, logistic regression analysis showed that the size of duodenal SELs was an independent factor for R0 resection during the ER-L procedure. Conclusion: in conclusion, ER-L is feasible and safe to remove duodenal SELs that originate from the submucosal layer and are less than 20 mm. However, the feasibility and safety of the ER-L should be further confirmed when removing the duodenal SELs that originate from the muscularis propria (MP) layer and are larger than 20 mm in diameter.
Share Button
New comment
Comments
No comments for this article
References
1. Humphris JL, Jones DB. Subepithelial mass lesions in the upper gastrointestinal tract. J Gastroenterol Hepatol 2008;23:556-66.
2. Matsumoto S, Miyatani H, Yoshida Y. Endoscopic submucosal dissection for duodenal tumors: a single-center experience. Endoscopy 2013;45:136-7.
3. Musumba C, Sonson R, Tutticci N, et al. Endoscopic submucosal dissection of a duodenal neuroendocrine tumor. Gastrointest Endosc 2014;79:716.
4. Miettinen M, Lasota J. Gastrointestinal stromal tumors: pathology and prognosis at different sites. Semin Diagn Pathol 2006;23:70-83.
5. Cho JW, Korean ESDSG. Current Guidelines in the Management of Upper Gastrointestinal Subepithelial Tumors. Clin Endosc 2016;49:235-40.
6. Meesters B, Pauwels PA, Pijnenburg AM, et al. Metastasis in a benign duodenal stromal tumour. Eur J Surg Oncol 1998;24:334-5.
7. Fletcher CD, Berman JJ, Corless C, et al. Diagnosis of gastrointestinal stromal tumors: A consensus approach. Hum Pathol 2002;33:459-65.
8. Seo JY, Hong SJ, Han JP, et al. Usefulness and safety of endoscopic treatment for nonampullary duodenal adenoma and adenocarcinoma. J Gastroenterol Hepatol 2014;29:1692-8.
9. Gaspar JP, Stelow EB, Wang AY. Approach to the endoscopic resection of duodenal lesions. World J Gastroenterol 2016;22:600-17.
10. Gincul R, Ponchon T, Napoleon B, et al. Endoscopic treatment of sporadic small duodenal and ampullary neuroendocrine tumors. Endoscopy 2016;48:979-986.
11. Kim TW, Kim GH, Park DY, et al. Endoscopic resection for duodenal subepithelial tumors: a single-center experience. Surg Endosc 2017;31:1936-1946.
12. Basford P, Bhandari P. Endoscopic resection of sporadic duodenal neuroendocrine tumors: Why is this not so easy? Endoscopy 2016;48:965-966.
13. Chok AY, Koh YX, Ow MY, et al. A systematic review and meta-analysis comparing pancreaticoduodenectomy versus limited resection for duodenal gastrointestinal stromal tumors. Ann Surg Oncol 2014;21:3429-38.
14. Yang F, Jin C, Du Z, et al. Duodenal gastrointestinal stromal tumor: clinicopathological characteristics, surgical outcomes, long term survival and predictors for adverse outcomes. Am J Surg 2013;206:360-7.
15. Ye LP, Mao XL, Zheng HH, et al. Safety of endoscopic resection for duodenal subepithelial lesions with wound closure using clips and an endoloop: an analysis of 68 cases. Surg Endosc 2017;31:1070-1077.
16. Lepilliez V, Chemaly M, Ponchon T, et al. Endoscopic resection of sporadic duodenal adenomas: an efficient technique with a substantial risk of delayed bleeding. Endoscopy 2008;40:806-10.
17. Bourke MJ. Endoscopic resection in the duodenum: current limitations and future directions. Endoscopy 2013;45:127-32.
18. Yamamoto H, Miura Y. Duodenal ESD: conquering difficulties. Gastrointest Endosc Clin N Am 2014;24:235-44.
19. Ren Z, Lin SL, Zhou PH, et al. Endoscopic full-thickness resection (EFTR) without laparoscopic assistance for nonampullary duodenal subepithelial lesions: our clinical experience of 32 cases. Surg Endosc 2019;33:3605-3611.
20. Kappelle WFW, Backes Y, Valk GD, et al. Endoscopic full-thickness resection of gastric and duodenal subepithelial lesions using a new, flat-based over-the-scope clip. Surg Endosc 2018;32:2839-2846.
Related articles

Digestive Diseases Image

Endoscopic resection of a descending duodenal polyp with the string-clip traction

DOI: 10.17235/reed.2022.8915/2022

Citation tools
Li D, Shi R, Xiong F, Zhang H, Liu T, Tian Y, et all. Endoscopic resection in combination with ligation for the treatment of duodenal subepithelial lesions: a single-center experience. 8105/2021


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 2040 visits.
This article has been downloaded 112 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 16/05/2021

Accepted: 17/09/2021

Online First: 27/09/2021

Published: 07/06/2022

Article revision time: 122 days

Article Online First time: 134 days

Article editing time: 387 days


Share
This article has been rated by 1 readers.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2024 y Creative Commons. The Spanish Journal of Gastroenterology