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.
Fig. 1 An 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. 2 The biopsy specimen obtained from the lesion revealed a well-differentiated tubular adenocarcinoma (H & E, original magnification × 40).
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.
Fig. 3 The lesion was completely resected with a safe lateral and vertical margin.
Fig. 4 After the resection the scar was closed by hemoclips to prevent perforation.
Fig. 5 No recurrence has been observed in more than 3 years since the ESD was carried out.
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
