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DOI: 10.1055/s-2007-995685
© Georg Thieme Verlag KG Stuttgart · New York
Successful endoscopic submucosal dissection of duodenal cancer
M. Shimada, MD, PhD
Department of Gastroenterology
Internal Medicine
TMG Asakadai Central General Hospital
1-8-10, Nishi-benzai, Asaka-shi
Saitama 351-8551
Japan
Fax: + 81-48-4662735
Email: shimada@kanazawa-med.ac.jp
Publication History
Publication Date:
16 July 2008 (online)
This is the first report of complete resection of early duodenal cancer using endoscopic submucosal dissection (ESD) monotherapy.
A 66-year-old Japanese man visited the hospital in order to undergo screening for cancer on June 2004. Endoscopic examination of the upper digestive tract revealed a faintly marked, red, depressed (0-IIc) lesion, 3.5 × 3.0 mm in diameter, on the posterior wall of the duodenal cap ([Fig. 1]). The biopsy specimen obtained from the lesion revealed a well-differentiated tubular adenocarcinoma ([Fig. 2]). No metastasis to any other organ was found. A barium X-ray study showed there was no notable duodenal transformation. In addition, the lesion showed the lifting sign after submucosal saline injection [1] [2]. This lesion was diagnosed as a mucosal duodenal cancer. ESD was selected for this patient after histological confirmation of the diagnosis. A cylindrical transparent hood was attached to the endoscope to maintain a satisfactory view during the procedure.
ESD was carried out primarily using the flex knife (KD-630L; Olympus) and hook knife (KD-620LR; Olympus) as described previously by Kodashima and Rösch [3] [4] ([Fig. 3]). Bleeding during the procedure was managed by the administration of thrombin and by snare coagulation. Some hemoclips were also used to prevent perforation ([Fig. 4]). No recurrence has been found in more than 3 years since ESD ([Fig. 5]). In this patient, the successful outcome depended on two points: (i) the use of hemoclips on the scar after resection, and (ii) the attachment of a cylindrical transparent hood to the endoscope, which together made the ESD easier and safer.
ESD might be one of the most effective and useful techniques for the treatment of early duodenal cancer in the future.
Endoscopy_UCTN_Code_TTT_1AO_2AG
#References
- 1 Han K S, Sohn D K, Choi D H. et al . Prolongation of the period between biopsy and EMR can influence the nonlifting sign in endoscopically resectable colorectal cancers. Gastrointest Endosc. 2008; 67 97-102
- 2 Kobayashi N, Saito Y, Sano Y. et al . Determining the treatment strategy for colorectal neoplastic lesions: endoscopic assessment or the non-lifting sign for diagnosing invasion depth?. Endoscopy. 2007; 39 701-705
- 3 Kodashima S, Fujishiro M, Yahagi N. et al . Endoscopic submucosal dissection using flexknife. J Clin Gastroenterol. 2006; 40 378-384
- 4 Rösch T, Sarbia M, Schumacher B. et al . Attempted endoscopic en bloc resection of mucosal and submucosal tumors using insulated-tip knives: a pilot series. Endoscopy. 2004; 36 788-801
M. Shimada, MD, PhD
Department of Gastroenterology
Internal Medicine
TMG Asakadai Central General Hospital
1-8-10, Nishi-benzai, Asaka-shi
Saitama 351-8551
Japan
Fax: + 81-48-4662735
Email: shimada@kanazawa-med.ac.jp
References
- 1 Han K S, Sohn D K, Choi D H. et al . Prolongation of the period between biopsy and EMR can influence the nonlifting sign in endoscopically resectable colorectal cancers. Gastrointest Endosc. 2008; 67 97-102
- 2 Kobayashi N, Saito Y, Sano Y. et al . Determining the treatment strategy for colorectal neoplastic lesions: endoscopic assessment or the non-lifting sign for diagnosing invasion depth?. Endoscopy. 2007; 39 701-705
- 3 Kodashima S, Fujishiro M, Yahagi N. et al . Endoscopic submucosal dissection using flexknife. J Clin Gastroenterol. 2006; 40 378-384
- 4 Rösch T, Sarbia M, Schumacher B. et al . Attempted endoscopic en bloc resection of mucosal and submucosal tumors using insulated-tip knives: a pilot series. Endoscopy. 2004; 36 788-801
M. Shimada, MD, PhD
Department of Gastroenterology
Internal Medicine
TMG Asakadai Central General Hospital
1-8-10, Nishi-benzai, Asaka-shi
Saitama 351-8551
Japan
Fax: + 81-48-4662735
Email: shimada@kanazawa-med.ac.jp