Clinical outcomes of endoscopic resection for nonampullary duodenal high-grade dysplasia and intramucosal carcinoma

D. Maruoka; M. Arai; T. Kishimoto; T. Matsumura; M. Inoue; T. Nakagawa; Y. Watanabe; T. Katsuno; T. Tsuyuguchi; F. Imazeki; O. Yokosuka

doi:10.1055/s-0032-1325799

Endoscopy, Table of Contents

Endoscopy 2013; 45(02): 138-141
DOI: 10.1055/s-0032-1325799

Case report/series

Clinical outcomes of endoscopic resection for nonampullary duodenal high-grade dysplasia and intramucosal carcinoma

D. Maruoka

¹Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan

²Department of Endoscopic Diagnostics and Therapeutics, Chiba University Hospital, Chiba, Japan

,

M. Arai

¹Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan

,

T. Kishimoto

³Department of Molecular Pathology, Graduate School of Medicine, Chiba University, Chiba, Japan

,

T. Matsumura

¹Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan

²Department of Endoscopic Diagnostics and Therapeutics, Chiba University Hospital, Chiba, Japan

,

M. Inoue

²Department of Endoscopic Diagnostics and Therapeutics, Chiba University Hospital, Chiba, Japan

,

T. Nakagawa

¹Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan

,

Y. Watanabe

²Department of Endoscopic Diagnostics and Therapeutics, Chiba University Hospital, Chiba, Japan

,

T. Katsuno

¹Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan

,

T. Tsuyuguchi

¹Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan

²Department of Endoscopic Diagnostics and Therapeutics, Chiba University Hospital, Chiba, Japan

,

F. Imazeki

¹Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan

,

O. Yokosuka

¹Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan

²Department of Endoscopic Diagnostics and Therapeutics, Chiba University Hospital, Chiba, Japan

› Author Affiliations

Abstract

This study retrospectively analyzed the clinical outcomes of endoscopic resection of 26 sporadic (i. e., not associated with polyposis syndrome) nonampullary duodenal lesions representing high-grade dysplasia or intramucosal carcinoma (duodenal HGD/IMC) in 23 patients. No severe complications such as perforation were observed, but three cases of delayed bleeding were seen. The use of endoscopic clips significantly decreased the delayed bleeding rate (0 /19, 0 %) compared with cases in which clips were not used (3 /7, 42.9 %; P = 0.013, χ² test). Eighteen lesions (69.2 %) were removed by en bloc resection. The follow-up period after resection was 25.5 ± 23.3 months. Two lesions (7.7 %) that recurred locally were detected at the first surveillance endoscopy 3 months after resection. These lesions were 22 and 15 mm in size respectively and were resected piecemeal. Endoscopic resection is an effective and safe procedure for treating duodenal HGD/IMC. En bloc resection and prophylactic clip usage are encouraged.

Full Text

References

References
1 Obata S, Suenaga M, Araki K et al. Use of strip biopsy in a case of early duodenal cancer. Endoscopy 1992; 24: 232-234
2 Apel D, Jakobs R, Spiethoff A et al. Follow-up after endoscopic snare resection of duodenal adenomas. Endoscopy 2005; 37: 444-448
3 Sohn JW, Jeon SW, Cho CM et al. Endoscopic resection of duodenal neoplasms: a single-center study. Surg Endosc 2010; 24: 3195-3200
4 Lépilliez 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: 806-810
5 Alexander S, Bourke MJ, Williams SJ et al. EMR of large, sessile, sporadic nonampullary duodenal adenomas: technical aspects and long-term outcome (with videos). Gastrointest Endosc 2009; 69: 66-73
6 Oka S, Tanaka S, Nagata S et al. Clinicopathologic features and endoscopic resection of early primary nonampullary duodenal carcinoma. J Clin Gastroenterol 2003; 37: 381-386
7 Inoue H, Endo M, Takeshita K et al. A new simplified technique of endoscopic esophageal mucosal resection using a cap-fitted panendoscope (EMRC). Surg Endosc 1992; 6: 264-265
8 Tada M, Murakami A, Karita M et al. Endoscopic resection of early gastric cancer. Endoscopy 1993; 25: 445-450
9 Dixon MF. Gastrointestinal epithelial neoplasia: Vienna revisited. Gut 2002; 51: 130-131
10 Shioji K, Suzuki Y, Kobayashi M et al. Prophylactic clip application does not decrease delayed bleeding after colonoscopic polypectomy. Gastrointest Endosc 2003; 57: 691-694
11 Spira IA, Ghazi A, Wolff WI. Primary adenocarcinoma of the duodenum. Cancer 1977; 39: 1721-1726
12 Ross RK, Hartnett NM, Bernstein L et al. Epidemiology of adenocarcinomas of the small intestine: is bile a small bowel carcinogen?. Br J Cancer 1991; 63: 143-145
13 Onoe S, Katoh T, Shibata Y et al. A clinicopathological study of our 10 cases with primary carcinoma of the duodenum [in Japanese with English abstract]. Jpn J Gastroenterol Surg 2006; 39: 1458-1463