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Korean J Gastroenterol. 2016 Jan;67(1):8-15. Korean.
Published online Jan 26, 2016.  https://doi.org/10.4166/kjg.2016.67.1.8
Copyright © 2016 The Korean Society of Gastroenterology
Endoscopic Resection of Sporadic Non-ampullary Duodenal Neoplasms: A Single Center Study
Yoon Jeong Nam, Si Hyung Lee, Kyeong Ok Kim, Byung Ik Jang, Tae Nyeun Kim and Yong Jin Kim1
Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.
1Department of Pathology, Yeungnam University College of Medicine, Daegu, Korea.

Correspondence to: Si Hyung Lee, Department of Internal Medicine, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea. Tel: +82-53-620-3842, Fax: +82-53-654-8386, Email: dr9696@nate.com
Received September 14, 2015; Revised October 25, 2015; Accepted November 10, 2015.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Abstract

Background/Aims

Sporadic non-ampullary duodenal neoplasms are rare and optimal treatment for these lesions remains undefined. Endoscopic resection of duodenal neoplasms is widely used recently and it is an alternative treatment strategy to surgical excision. This study aimed to evaluate the safety and efficacy of endoscopic resection of duodenal neoplasms and to determine its outcomes.

Methods

Patients who underwent endoscopic resection for non-ampullary duodenal neoplasms between January 2005 and December 2014 were analyzed retrospectively. Data including size, morphology, histology, location and endoscopic procedural technique were reviewed. The main outcome measurements were success rate, complication, recurrence and follow-up assessments.

Results

The study included 33 patients with duodenal neoplasms. The mean size of resected lesion was 8.58 mm. The results of histologic examination were as follows: 23 (69.7%) adenomas, 2 (6.1%) adenocarcinoma, 3 (9.1%) Brunner's gland tumor and 3 (9.1%) neuroendocrine tumor. Tubular adenoma wase the most common type (63.6%) of non-ampullary duodenal neoplasms. Eighteen (54.5%) lesions were found in the second portion of the duodenum, and 10 (30.3%) lesions on bulb and 3 (9.1%) lesions on superior duodenal angle. Of the 33 cases, 32 (97.0%) were managed by endoscopic mucosal resection technique during a single session and one case was managed by endoscopic submucosal dissection (ESD). One episode of perforation occurred after ESD. During a median follow-up period of 5.76 months, recurrence was observed in only one case of in a patient with tubular adenoma.

Conclusions

Endoscopic resection of duodenal neoplasm is a safe and effective treatment modality that can replace surgical resection in many cases. Careful endoscopic follow-up is essential to manage recurrence or residual lesions.

Keywords: Duodenal neoplasms

Figures


 Fig. 1
The results of endoscopic mucosal resection (EMR) for adenocarcinoma in two patients (A-D are the photographs of one patient and E-H of another). (A) A 15-mm lesion at duodenal 2nd portion. (B) Complete en bloc resection with clean margin. (C) Defect closed with 3 clips. (D) Three months after procedure. (E) A 7-mm lesion at bulb. (F) Complete en bloc resection with EMR and hemostasis using hemostatic forcep. (G) Defect closed with 2 clips. (H) Three months after procedure.
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Fig. 2
Microscopic findings (H&E). (A) Well differentiated adenocarcinoma portion (arrows) is surrounded by tubular adenoma (×40). (B) Well differentiated adenocarcinoma is limited at mucosa (×100).
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Fig. 3
Flow chart of treatment for duodenal neoplasms.
EMR, endoscopic mucosal resection; ESD, endoscopic submucosal dissection.
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Tables


 Table 1
Characteristics of Patients
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Table 2
Characteristics of Neoplasms
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Table 3
Characteristics of Procedure
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Table 4
Characteristics of Pathology
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Table 5
Analysis of Outcome
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Table 6
Characteristics of All Patients
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Table 7
Summary of Study Characteristics
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Notes

Financial support:None.

Conflict of interest:None.

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