Endoscopy 2018; 50(04): S152
DOI: 10.1055/s-0038-1637492
ESGE Days 2018 ePosters
Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC RESECTION OF DUODENAL LESIONS AND A SINGLE CENTER EXPERIENCE

M Mahadik
1   Deenanath Mangeshkar Hospital and Research Center, Pune, India
,
T Bharadwaj
2   Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India
,
S Kumar Korrapati
2   Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India
,
P Nemade
2   Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India
,
R Pujari
2   Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India
,
J Bapaye
2   Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India
,
S Date
2   Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India
,
A Bapaye
2   Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aims:

Endoscopic resection (ER)-either endoscopic submucosal dissection (ESD) or endoscopic full-thickness resection (EFTR) are treatment modalities for mucosal and sub epithelial lesions in the gastrointestinal tract. ESD or EFTR for duodenal lesions has been infrequently reported. This retrospective case series reports the results of ER for duodenal lesions.

Methods:

Eighteen consecutive patients with duodenal lesions over a six-year period (2010 – 16). All patients underwent Pre-procedure radial endosonography (EUS). EMR, ESD or EFTR was performed in all patients under general anesthesia. A high definition gastroscope (GIF-HQ-190, Olympus Corporation, Japan) with distal transparent attachment was used. EMR was performed using a diathermy snare. For ESD and EFTR DualknifeTM (Olympus) or HybridknifeTM (ERBE GmBH, Germany) was used. Hemostasis was achieved using CoagrasperTM (Olympus). For EFTR, closure was achieved using hemoclips (Olympus) or PadlockTM clip (Aponos Medical, USA).

Results:

N = 18, 14 males, mean age: 62.5 years (36 – 85). Thirteen (72%) lesions in duodenal bulb and 5 (28%) in descending duodenum. Layer of origin – mucosa -12 (67%), submucosa (SM) – 5 (28%), muscularis propria (MP) – 1. Mean cross sectional area of lesions -758 sq.mm (10 – 5600). EMR was performed in 8 (44%), ESD in 7 (39%) and EFTR in 3 (17%). EFTR defect was closed using omental patch and hemoclips in 1 and full-thickness clip in two patients. No intra procedural adverse events occured. Two delayed adverse events occurred (11%) – delayed hemorrhage – 1, delayed perforation – 1. No mortality. Final histology – neuroendocrine tumor – 11, hyperplastic polyp – 3, adenoma – 2, gastrointestinal stromal tumor – 1, and gangliocytic paraganglioma – 1. HPE showed clear margins in all. Follow up EGD at 4 – 6 weeks showed complete healing in all.

Conclusions:

ER for duodenal lesions is safe and effective. Type of procedure – EMR, ESD or EFTR depends on the layer of origin of the tumor.