Endoscopy 2017; 49(01): 8-14
DOI: 10.1055/s-0042-116315
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Duodenal endoscopic submucosal dissection is feasible using the pocket-creation method

Yoshimasa Miura
1   Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan
,
Satoshi Shinozaki
1   Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan
2   Shinozaki Medical Clinic, Tochigi, Japan
,
Yoshikazu Hayashi
1   Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan
,
Hirotsugu Sakamoto
1   Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan
,
Alan Kawarai Lefor
3   Department of Surgery, Jichi Medical University, Tochigi, Japan
,
Hironori Yamamoto
1   Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan
› Author Affiliations
Further Information

Publication History

submitted19 April 2016

accepted after revision25 July 2016

Publication Date:
22 November 2016 (online)

Abstract

Background and study aims Duodenal endoscopic submucosal dissection (ESD) requires sophisticated endoscopic techniques because of a high rate of perforation. We introduced the pocket-creation method (PCM) of duodenal ESD to overcome difficulties. The aim of this study was to evaluate the safety and usefulness of ESD using the PCM for superficial tumors of the duodenum.

Patients and methods We performed ESD of 17 non-ampullary duodenal lesions using the conventional method and of 28 lesions using the PCM from 2006 to 2015 and retrospectively reviewed the results, comparing the PCM and the conventional method. The median follow-up period was 35 months (range 2 – 97).

Results There were more lesions at the duodenal angles in the PCM group compared with the conventional method group (54 % [15/28] vs. 22 % [4/17]; P = 0.048), and the resected specimen diameter was larger in the PCM than the conventional method group (median 37 mm [range 25 – 101] vs. 25 mm [15 – 55]; P = 0.007). Dissection speed was faster in the PCM than the conventional method group (9.4 mm2/min [3.0 – 15.7] vs. 6.5 mm2/min [1.5 – 19.7]; P = 0.09). En bloc resection was more frequent in the PCM (100 % [28/28]) than the conventional method group (88 % [15/17]) (P = 0.07). Perforation was significantly less frequent in the PCM (7 % [2/28]) than the conventional method group (29 % [5/17]; P = 0.046). The one delayed perforation in the conventional method group required surgical repair, while other intraprocedural perforations were treated by clipping. There were no recurrences.

Conclusions ESD of duodenal lesions can be safely performed using the PCM, which stabilizes the tip of the endoscope even in difficult locations.

 
  • References

  • 1 Yamamoto H, Miura Y. Duodenal ESD: conquering difficulties. Gastrointest Endosc Clin N Am 2014; 24: 235-244
  • 2 Park SM, Ham JH, Kim BW. et al. Feasibility of endoscopic resection for sessile nonampullary duodenal tumors: a multicenter retrospective study. Gastroenterol Res Pract 2015; 2015: 692492
  • 3 Ishii N, Akiyama H, Suzuki K. et al. Safety and efficacy of endoscopic submucosal dissection for non-ampullary duodenal neoplasms: a case series. ACG Case Rep J 2015; 2: 146-149
  • 4 Nonaka S, Oda I, Tada K. et al. Clinical outcome of endoscopic resection for nonampullary duodenal tumors. Endoscopy 2015; 47: 129-135
  • 5 Hayashi Y, Miura Y, Yamamoto H. Pocket-creation method for the safe, reliable, and efficient endoscopic submucosal dissection of colorectal lateral spreading tumors. Dig Endosc 2015; 27: 534-535
  • 6 Hayashi Y, Sunada K, Takahashi H. et al. Pocket-creation method of endoscopic submucosal dissection to achieve en bloc resection of giant colorectal subpedunculated neoplastic lesions. Endoscopy 2014; 46 (Suppl. 01) E421-E422
  • 7 Yamamoto H, Hayashi Y, Sunada K. How to conquer difficult ESD: duodenum, fibrosis, and more. In: Fukami N. , ed. Endoscopic submucosal dissection –principles and practice. Heidelberg, Germany: Springer; 2015: 115-128
  • 8 Hayashi Y, Shinozaki S, Sunada K. et al. Efficacy and safety of endoscopic submucosal dissection for superficial colorectal tumors more than 50 mm in diameter. Gastrointest Endosc 2016; 83: 602-607
  • 9 Honda T, Yamamoto H, Osawa H. et al. Endoscopic submucosal dissection for superficial duodenal neoplasms. Dig Endosc 2009; 21: 270-274
  • 10 Matsumoto S, Miyatani H, Yoshida Y. Endoscopic submucosal dissection for duodenal tumors: a single-center experience. Endoscopy 2013; 45: 136-137
  • 11 Jung JH, Choi KD, Ahn JY. et al. Endoscopic submucosal dissection for sessile, nonampullary duodenal adenomas. Endoscopy 2013; 45: 133-135
  • 12 Hoteya S, Yahagi N, Iizuka T. et al. Endoscopic submucosal dissection for nonampullary large superficial adenocarcinoma/adenoma of the duodenum: feasibility and long-term outcomes. Endosc Int Open 2013; 1: 2-7
  • 13 Yamamoto Y, Yoshizawa N, Tomida H. et al. Therapeutic outcomes of endoscopic resection for superficial non-ampullary duodenal tumor. Dig Endosc 2014; 26 (Suppl. 02) 50-56
  • 14 Higaki S, Hashimoto S, Harada K. et al. Long-term follow-up of large flat colorectal tumors resected endoscopically. Endoscopy 2003; 35: 845-849
  • 15 Hotta K, Fujii T, Saito Y. et al. Local recurrence after endoscopic resection of colorectal tumors. Int J Colorectal Dis 2009; 24: 225-230
  • 16 Saito Y, Fukuzawa M, Matsuda T. et al. Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection. Surg Endosc 2010; 24: 343-352
  • 17 Terasaki M, Tanaka S, Oka S. et al. Clinical outcomes of endoscopic submucosal dissection and endoscopic mucosal resection for laterally spreading tumors larger than 20 mm. J Gastroenterol Hepatol 2012; 27: 734-740
  • 18 Sakamoto T, Matsuda T, Otake Y. et al. Predictive factors of local recurrence after endoscopic piecemeal mucosal resection. J Gastroenterol 2012; 47: 635-640
  • 19 Tanaka S, Haruma K, Oka S. et al. Clinicopathologic features and endoscopic treatment of superficially spreading colorectal neoplasms larger than 20 mm. Gastrointest Endosc 2001; 54: 62-66