Clin Endosc.  2022 Jan;55(1):15-21. 10.5946/ce.2021.141.

Current Treatment Strategy for Superficial Nonampullary Duodenal Epithelial Tumors

• Suwa T
• Takizawa K
• Kawata N
• Yoshida M
• Yabuuchi Y
• Yamamoto Y
• Ono H

• KMID: 2525043
• DOI: http://doi.org/10.5946/ce.2021.141

Abstract

Endoscopic submucosal dissection (ESD) is the standard treatment method for esophageal, gastric, and colorectal cancers. However, it has not been standardized for duodenal lesions because of its high complication rates. Recently, minimally invasive and simple methods such as cold snare polypectomy and underwater endoscopic mucosal resection have been utilized more for superficial nonampullary duodenal epithelial tumors (SNADETs). Although the rate of complications associated with duodenal ESD has been gradually decreasing because of technical advancements, performing ESD for all SNADETs is unnecessary. As such, the appropriate treatment plan for SNADETs should be chosen according to the lesion type, patient condition, and endoscopist’s skill.

Keyword

Cold snare polypectomy; Duodenal tumor; Endoscopic resection; Superficial nonampullary duodenal epithelial tumors; Underwater endoscopic mucosal resection

Figure

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  Fig. 1. Cold snare polypectomy (CSP) for superficial nonampullary duodenal epithelial tumors. (A) White light imaging. A 9 mm white, slightly elevated lesion (0-IIa) was located in the 2nd portion of the duodenum, and the pathological diagnosis by biopsy in the former clinic was low grade dysplasia. (B) Indigo carmine staining. (C) Snaring of the entire lesion with surrounding mucosa and resection without a high-frequency device. (D) No residue at the mucosal defects. (E) Post-CSP clipping was performed completely. (F) Lesion was grossly 8 mm in size. (G) Hematoxylin and eosin staining. The pathological diagnosis was tubular adenoma, HM0, VM0. (H) Three months after CSP. No residual lesion or recurrence.

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  Fig. 2. Underwater endoscopic mucosal resection (UEMR) for superficial nonampullary duodenal epithelial tumors. (A) White light imaging. A 15 mm white, slightly elevated lesion (0-IIa) was located in the 2nd portion of the duodenum; a preoperative biopsy was not performed. (B) Complete air deflation in the lumen, followed by filling with water. (C) Snaring of the entire lesion with surrounding mucosa and resection with a high-frequency device. (D) No residue at the mucosal defects. (E) Post-UEMR clipping was performed completely. (F) Lesion was grossly 14 mm in size. (G) Hematoxylin and eosin staining. The pathological diagnosis was tubular adenoma, HM0, VM0. (H) Three months after UEMR. No residual lesion or recurrence.

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  Fig. 3. Our proposal of the treatment strategy for superficial nonampullary duodenal epithelial tumors. CSP, cold snare polypectomy; cEMR, conventional endoscopic mucosal resection; ESD, endoscopic submucosal dissection; D-LECS, laparoscopic and endoscopic cooperative surgery for duodenal tumors; SNADETs, superficial nonampullary duodenal epithelial tumors; UEMR, underwater endoscopic mucosal resection. a)carcinoma=intramucosal carcinoma. b)ESD should only be performed at high-volume centers.

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