Published online Jul 27, 2017. doi: 10.4240/wjgs.v9.i7.161
Peer-review started: December 30, 2016
First decision: January 28, 2017
Revised: May 26, 2017
Accepted: June 6, 2017
Article in press: June 8, 2017
Published online: July 27, 2017
To investigate predictors of perforation after endoscopic resection (ER) for duodenal neoplasms without a papillary portion.
This was a single-center, retrospective, cohort study conducted between April 2003 and September 2014. A total of 54 patients (59 lesions) underwent endoscopic mucosal resection (EMR) (n = 36) and endoscopic submucosal dissection (ESD) (n = 23). Clinical features, outcomes, and predictors of perforation were investigated.
Cases of perforation occurred in eight (13%) patients (95%CI: 4.7%-22.6%). Three ESD cases required surgical management because they could not be repaired by clipping. Delayed perforation occurred in two ESD cases, which required surgical management, although both patients underwent prophylactic clipping. All patients with perforation who required surgery had no postoperative complications and were discharged at an average of 13.2 d after ER. Perforation after ER showed a significant association with a tumor size greater than 20 mm (P = 0.014) and ESD (P = 0.047).
ESD for duodenal neoplasms exceeding 20 mm may be associated with perforation. ESD alone is not recommended for tumor treatment, and LECS should be considered as an alternative.
Core tip: Duodenal neoplasms are relatively rare, and endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) of the duodenum poses a high risk of complications. In our study, 54 patients (59 lesions) underwent EMR (n = 36) and ESD (n = 23). Cases of perforation occurred in eight (13%) patients (95%CI: 4.7%-22.6%), and perforation showed a significant association with a tumor size greater than 20 mm (P = 0.014) and ESD (P = 0.047). ESD for duodenal neoplasms exceeding 20 mm may be associated with perforation. ESD alone is not recommended as a treatment for tumor treatment, and laparoscopic and endoscopic cooperative surgery should be considered as an alternative.