ENDOSCOPIC SUBMUCOSAL DISSECTION USING THE SHORT TYPE CLUTCH CUTTER FOR SUPERFICIAL NON-AMPULLARY DUODENAL EPITHELIAL TUMORS

Background and study aim:

Endoscopic submucosal dissection (ESD) using conventional knives for superficial non-ampullary duodenal epithelial tumors (SNADET) is technically demanding and the reported perforation rate was 25%. The aim of this study was to evaluate the efficacy and safety of ESD using the short type CC for SNADET.

Patients and methods:

From September 2009 to March 2018, 15 consecutive patients (6 men, 9 women; mean age 60 years, range 52 – 91) with a diagnosis of SNADET confirmed by preliminary endoscopy, EUS, and endoscopic biopsies, were enrolled into this prospective study. The short type CC (blade length 3.5 mm) was used for all steps of ESD (mucosal incision, submucosal dissection, and hemostatic treatment). The therapeutic efficacy and safety were assessed.

Results:

Tumor location included 2 lesions in the bulbus, 10 lesions in the 2^nd portion, and 3 lesions in the 3^rd portion. The final histopathological diagnoses of the resected specimens were 5 cases of adenocarcinoma, 9 cases of adenoma, and 1 case of heterotopic gastric mucosa. The mean sizes of the SNADETs and resected specimens were 19 ± 11 mm and 28 ± 11 mm respectively. The mean operating time was 119 ± 80 minutes. The rates of en-bloc resection and R0 resection were 93% (14/15) and 67% (10/15), respectively. We encountered intraoperative perforation in 1 case (7%), which was successfully treated by following endoscopic clipping and conservative treatment. There were no perforations or bleeding after ESD using the short type CC.

Conclusions:

ESD using the short type CC appears to be a relatively safe and technically efficient method for resecting SNADET.