Endoscopy 2017; 49(01): 8-14
DOI: 10.1055/s-0042-116315
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Duodenal endoscopic submucosal dissection is feasible using the pocket-creation method

Yoshimasa Miura
1   Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan
,
Satoshi Shinozaki
1   Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan
2   Shinozaki Medical Clinic, Tochigi, Japan
,
Yoshikazu Hayashi
1   Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan
,
Hirotsugu Sakamoto
1   Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan
,
Alan Kawarai Lefor
3   Department of Surgery, Jichi Medical University, Tochigi, Japan
,
Hironori Yamamoto
1   Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan
› Institutsangaben
Weitere Informationen

Publikationsverlauf

submitted19. April 2016

accepted after revision25. Juli 2016

Publikationsdatum:
22. November 2016 (online)

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Abstract

Background and study aims Duodenal endoscopic submucosal dissection (ESD) requires sophisticated endoscopic techniques because of a high rate of perforation. We introduced the pocket-creation method (PCM) of duodenal ESD to overcome difficulties. The aim of this study was to evaluate the safety and usefulness of ESD using the PCM for superficial tumors of the duodenum.

Patients and methods We performed ESD of 17 non-ampullary duodenal lesions using the conventional method and of 28 lesions using the PCM from 2006 to 2015 and retrospectively reviewed the results, comparing the PCM and the conventional method. The median follow-up period was 35 months (range 2 – 97).

Results There were more lesions at the duodenal angles in the PCM group compared with the conventional method group (54 % [15/28] vs. 22 % [4/17]; P = 0.048), and the resected specimen diameter was larger in the PCM than the conventional method group (median 37 mm [range 25 – 101] vs. 25 mm [15 – 55]; P = 0.007). Dissection speed was faster in the PCM than the conventional method group (9.4 mm2/min [3.0 – 15.7] vs. 6.5 mm2/min [1.5 – 19.7]; P = 0.09). En bloc resection was more frequent in the PCM (100 % [28/28]) than the conventional method group (88 % [15/17]) (P = 0.07). Perforation was significantly less frequent in the PCM (7 % [2/28]) than the conventional method group (29 % [5/17]; P = 0.046). The one delayed perforation in the conventional method group required surgical repair, while other intraprocedural perforations were treated by clipping. There were no recurrences.

Conclusions ESD of duodenal lesions can be safely performed using the PCM, which stabilizes the tip of the endoscope even in difficult locations.