Endoscopic resection in the duodenum: current limitations and future directions

Duodenal lesions that should be considered for endoscopic resection comprise a heterogeneous group of disorders. Most are adenomas, primarily located in the descending duodenum. In comparison to lesions of a similar size elsewhere in the gastrointestinal tract, the risk of major complications from endoscopic resection of duodenal lesions is magnified. The unique anatomical features of the duodenum are largely responsible for this, but despite this we continue to apply conventional endoscopic therapies when a more sophisticated approach is required. Many other important clinical questions in relation to duodenal adenomas remain unanswered. This review aims to identify the gaps in the knowledge base and therapeutic approach and propose some solutions and directions for future research.

• References

• 1 Culver EL, McIntyre AS. Sporadic duodenal polyps: classification, investigation and management. Endoscopy 2001; 43: 144-155
• 2 Spigelman AD, Talbot IC, Penna C et al. Evidence for adenoma-carcinoma sequence in the duodenum of patients with familial adenomatous polyposis. The Leeds Castle Polyposis Group (Upper Gastrointestinal Committee). J Clin Pathol 1994; 47: 709-710
• 3 Murray MA, Zimmerman MJ, Ee HC. Sporadic duodenal adenoma is associated with colorectal neoplasia. Gut 2004; 53: 261-265
• 4 Dariusz A, Jochen R. Increased prevalence of colorectal adenoma in patients with sporadic duodenal adenoma. Eur J Gastroenterol Hepatol 2009; 21: 816-818
• 5 Lynch HT, Smyrk TC, Lanspa SJ et al. Upper gastrointestinal manifestations in families with hereditary flat adenoma syndrome. Cancer 1993; 71: 2709-2714
• 6 Vogt S, Jones N, Christian D et al. Expanded extracolonic tumor spectrum in MUTYH-associated polyposis. Gastroenterology 2009; 137: 1976-1985
• 7 Moss A, Bourke MJ, Williams SJ et al. Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia. Gastroenterology 2011; 140: 1909-1918
• 8 Uraoka T, Saito Y, Matsuda T et al. Endoscopic indications for endoscopic mucosal resection of laterally spreading tumours in the colorectum. Gut 2006; 55: 1592-1597
• 9 Holt BA, Bourke MJ. Wide field endoscopic resection for advanced colonic mucosal neoplasia: current status and future directions. Clin Gastroenterol Hepatol 2012; 10: 969-979
• 10 Fanning SB, Bourke MJ, Williams SJ et al. Giant laterally spreading tumors of the duodenum: endoscopic resection outcomes, limitations, and caveats. Gastrointest Endosc 2012; 75: 805-812
• 11 Conio M, De Ceglie A, Filiberti R et al. Cap-assisted EMR of large, sporadic, nonampullary duodenal polyps. Gastrointest Endosc 2012; 76: 1160-1169
• 12 Honda T, Yamamoto H, Osawa H et al. Endoscopic submucosal dissection for superficial duodenal neoplasms. Dig Endosc 2009; 21: 270-274
• 13 Moss A, Bourke MJ, Metz AJ. A randomized, double-blind trial of succinylated gelatin submucosal injection for endoscopic resection of large sessile polyps of the colon. Am J Gastroenterol 2011; 105: 2375-2382
• 14 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
• 15 Ahmad NA, Kochman ML, Long WB et al. Efficacy, safety, and clinical outcomes of endoscopic mucosal resection: a study of 101 cases. Gastrointest Endosc 2002; 55: 390-396
• 16 Abbass R, Rigaux J, Al-Kawas FH. Nonampullary duodenal polyps: characteristics and endoscopic management. Gastrointest Endosc 2010; 71: 754-759
• 17 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
• 18 Kedia P, Brensinger C, Ginsberg G. Endoscopic predictors of successful endoluminal eradication in sporadic duodenal adenomas and its acute complications. Gastrointest Endosc 2010; 72: 1297-1301
• 19 Bourke M. Endoscopic mucosal resection in the colon: a practical guide. Techniques Gastrointest Endosc 2011; 13: 35-49
• 20 Birkmeyer JD, Siewers AE, Finlayson EV et al. Hospital volume and surgical mortality in the United States. N Engl J Med 2002; 346: 1128-1137
• 21 Birkmeyer JD, Sun Y, Wong SL et al. Hospital volume and late survival after cancer surgery. Ann Surg 2007; 245: 277-283
• 22 Alexander S, Bourke MJ, Williams SJ et al. Endoscopic mucosal resection of large sessile sporadic non-ampullary duodenal adenomas: technical aspects and longterm outcome (with videos). Gastrointest Endosc 2009; 69: 66-73
• 23 Sohn JW, Jeon SW, Cho CM et al. Endoscopic resection of duodenal neoplasms: a single-center study. Surg Endosc 2010; 24: 3195-3200
• 24 Bourke MJ. Advances in endoscopy: bleeding following wide field mucosal resection in the colon. Gastroenterol Hepatol (N Y) 2011; 7: 814-817
• 25 Voermans RP, Le Moine O, von Renteln D et al. Efficacy of endoscopic closure of acute perforations of the gastrointestinal tract. Clin Gastroenterol Hepatol 2012; 10: 603-608
• 26 Bassan MS, Holt B, Moss A et al. Carbon dioxide insufflation reduces number of postprocedure admissions after endoscopic resection of large colonic lesions: a prospective cohort study. Gastrointest Endosc 2012; [Epub ahead of print]
• 27 Matsumoto S, Miyatani H, Yoshida Y. Endoscopic submucosal dissection for duodenal tumors: a single-center experience. Endoscopy 2013;
• 28 Jung JH, Choi KD, Ahn JY et al. Endoscopic submucosal dissection for sessile, non-ampullary duodenal adenomas. Endoscopy 2013;
• 29 Maruoka D, Arai M, Kishimoto T et al. Clinical outcomes of endoscopic resection for nonampullary duodenal high-grade dysplasia and intramucosal carcinoma. Endoscopy 2013;