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World J Gastrointest Endosc. Apr 16, 2015; 7(4): 389-395
Published online Apr 16, 2015. doi: 10.4253/wjge.v7.i4.389
Future directions of duodenal endoscopic submucosal dissection
Satohiro Matsumoto, Hiroyuki Miyatani, Yukio Yoshida
Satohiro Matsumoto, Hiroyuki Miyatani, Yukio Yoshida, Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Saitama 330-8503, Japan
Author contributions: Matsumoto S wrote the paper; all authors approved the final manuscript.
Conflict-of-interest: The authors have declared that no competing interests exist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Satohiro Matsumoto, MD, PhD, Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama 330-8503, Japan. s.w.himananon@ac.auone-net.jp
Telephone: +81-48-6472111 Fax: +81-48-6485188
Received: July 20, 2014
Peer-review started: July 20, 2014
First decision: November 14, 2014
Revised: January 6, 2015
Accepted: January 18, 2015
Article in press: January 20, 2015
Published online: April 16, 2015
Abstract

Endoscopic therapies for lesions of the duodenum are technically more difficult than those for lesions of the other parts of the gastrointestinal tract due to the anatomical features of the duodenum, and the incidence rate of complications such as perforation and bleeding is also higher. These aforementioned trends were especially noticeable for the case of duodenal endoscopic submucosal dissection (ESD). The indication for ESD of duodenal tumors should be determined by assessment of the histopathology, macroscopic morphology, and diameter of the tumors. The three types of candidate lesions for endoscopic therapy are adenoma, carcinoma, and neuroendocrine tumors. For applying endoscopic therapies to duodenal lesions, accurate preoperative histopathological diagnosis is necessary. The most important technical issue in duodenal ESD is the submucosal dissection process. In duodenal ESD, a short needle-type knife is suitable for the mucosal incision and submucosal dissection processes, and the Small-caliber-tip Transparent hood is an important tool. After endoscopic therapies, the wound should be closed by clipping in order to prevent complications such as secondary hemorrhage and delayed perforation. At present, the criteria for selection between ESD and EMR vary among institutions. The indications for ESD should be carefully considered. Duodenal ESD should have limitations, such as the need for its being performed by experts with abundant experience in performing the procedure.

Keywords: Duodenal tumor, Endoscopic submucosal dissection, Cancer, Adenoma, Neuroendocrine tumor, Technical know-how, Complication, Endoscopic mucosal resection

Core tip: Endoscopic therapies for duodenal lesions are technically more difficult than those for lesions of the other parts of the gastrointestinal tract due to the anatomical features of the duodenum, and the incidence rate of complications such as perforation is also higher. These aforementioned trends were especially noticeable for the case of duodenal endoscopic submucosal dissection (ESD). Thus, the indications for ESD should be carefully considered. For applying endoscopic therapies to duodenal lesions, accurate preoperative histopathological diagnosis is necessary. At present, duodenal ESD should have limitations, such as the need for its being performed by experts with abundant experience in performing the procedure.