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

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.

• 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