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Iwata K, Kato M, Nakayama A, Kanai T, Yahagi N. Case report: A case of laterally spreading duodenal cancer with slight submucosal invasion accompanied with concurrent lymph nodes metastasis. DEN OPEN 2022; 2:e100. [PMID: 35873515 PMCID: PMC9302270 DOI: 10.1002/deo2.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Kentaro Iwata
- Department of Internal Medicine Division of Gastroenterology and Hepatology Keio University School of Medicine Tokyo Japan
- Division of Research and Development for Minimally Invasive Treatment Cancer Center Keio University School of Medicine Tokyo Japan
| | - Motohiko Kato
- Department of Internal Medicine Division of Gastroenterology and Hepatology Keio University School of Medicine Tokyo Japan
- Division of Research and Development for Minimally Invasive Treatment Cancer Center Keio University School of Medicine Tokyo Japan
| | - Atsushi Nakayama
- Division of Research and Development for Minimally Invasive Treatment Cancer Center Keio University School of Medicine Tokyo Japan
| | - Takanori Kanai
- Department of Internal Medicine Division of Gastroenterology and Hepatology Keio University School of Medicine Tokyo Japan
| | - Naohisa Yahagi
- Division of Research and Development for Minimally Invasive Treatment Cancer Center Keio University School of Medicine Tokyo Japan
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Kim EY, Kim DJ, Lee HH, Lee JH, Kim JG, Song KY, Kim JJ, Chin HM, Kim W. Clinicopathological features and management strategy for superficial nonampullary duodenal tumors: a multi-center retrospective study. Ann Surg Treat Res 2022; 102:263-270. [PMID: 35611085 PMCID: PMC9111962 DOI: 10.4174/astr.2022.102.5.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/28/2022] [Accepted: 04/12/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose We investigated the clinicopathological features and management for superficial nonampullary duodenal tumors (SNADTs). The safety and feasibility of laparoscopic management, especially laparoscopic endoscopic cooperative surgery (LECS), were evaluated. Methods A total of 59 patients with SNADTs who underwent operations from January 2009 to December 2018 at all 8 institutions of the Catholic Medical Center were identified in our comprehensive multi-institutional database. Clinicopathological and surgical data on the 4 anatomical regions of the duodenum were collected and compared. Characteristics of conventional laparoscopic procedure (laparoscopy-only) and LECS procedures were also compared. Results There were significantly more asymptomatic patients with tumors in the first and second vs. third and fourth duodenal regions. Gastrointestinal stromal tumors (GISTs), carcinoids, and ectopic pancreatic tumors were identified in 32, 12, and 5 cases, respectively. Forty-two patients (71.2%) underwent laparoscopy. Of patients undergoing laparoscopy, the LECS group exhibited significantly more endophytic features and smaller tumor sizes (P < 0.001 and P < 0.001, respectively). Although no significant difference in the wedge resection or postoperative complication rate was seen between the 2 groups (P = 0.096 and P = 0.227, respectively), the wedge resection rate was higher, and the complication rate lower, in the LECS group than the conventional laparoscopic surgery group. Conclusion Most of the SNADTs located in proximal duodenum were detected incidentally. GISTs were the most common diagnoses of SNADTs in all locations. In treating these tumors, laparoscopic resection is safe and feasible. Especially, LECS may be ideal for treating small endophytic tumors, minimizing over-resection and postoperative complications.
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Affiliation(s)
- Eun Young Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Jin Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Han Hong Lee
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun Hyun Lee
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong Goo Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyo Young Song
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Jo Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyung Min Chin
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Wook Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Yadav A, Nundy S. Case series of non-ampullary duodenal adenomas. Ann Med Surg (Lond) 2021; 69:102730. [PMID: 34484721 PMCID: PMC8408424 DOI: 10.1016/j.amsu.2021.102730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/15/2021] [Accepted: 08/15/2021] [Indexed: 12/02/2022] Open
Abstract
Duodenal adenomas are benign tumours of the duodenum which carry a malignant potential. They are found either sporadically or associated with familial syndromes. Majority of these cases are treated endoscopically but surgical resection is a better alternate to endoscopy in select cases. Endoscopic treatment is associated with higher chances of local recurrence and require frequent check endoscopies in the follow up period, while surgery offers a one-time treatment option. Identification of the ampulla and a duodenal resection sparing ampullary area becomes difficult in larger lesions of the 2nd part of the duodenum. Passage of a catheter from cystic duct through common bile duct to duodenum aids in identification of the ampullary area and is helpful in performing a local/wedge resection of the duodenum containing adenoma without injuring ampullary orifice.
Duodenal adenomas carry malignant potential. Found sporadically or with familial syndromes. Surgery offers one time treatment options for larger lesions. Isolating the ampullary orifice through catheterization of the cystic duct is useful.
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Affiliation(s)
- Amitabh Yadav
- Corresponding author. 33/13, First Floor, East Patel Nagar, New Delhi, 110008, India.
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Intraoperative Endoscopy in Transient Adult Jejunojejunal Intussusception. Case Rep Gastrointest Med 2021; 2021:3718089. [PMID: 34336311 PMCID: PMC8289613 DOI: 10.1155/2021/3718089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/08/2021] [Indexed: 11/22/2022] Open
Abstract
Despite improvements in imaging modalities, causative lead points in adult intussusception may be difficult to diagnose. Such lead points can be malignant, causing recurrence or metastases if left unresected. We describe a case of transient adult jejunojejunal intussusception, in which intraoperative endoscopy was used to confirm the absence of a lead point. A 39-year-old woman with a history of laparoscopic oophorectomy presented with epigastric pain, nausea, and vomiting. Contrast computed tomography revealed jejunojejunal intussusception, with no visible lead point. Spontaneous reduction was confirmed during exploratory laparoscopy. After lysis of adhesions, intraoperative peroral jejunoscopy was performed with the surgeons' assistance. Endoscopy confirmed the absence of tumor, and bowel resection was avoided. No recurrence has been observed during 24 months of follow-up. Intraoperative endoscopy may provide additional reassurance for the absence of a lead point in cases where preoperative enteroscopy cannot be performed and no lead points can be identified on imaging.
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Kim DH, Park JH, Cho JK, Yang JW, Kim TH, Jeong SH, Kim YH, Lee YJ, Hong SC, Jung EJ, Ju YT, Jeong CY, Kim JY. Traumatic neuroma of remnant cystic duct mimicking duodenal subepithelial tumor: A case report. World J Clin Cases 2020; 8:3821-3827. [PMID: 32953859 PMCID: PMC7479553 DOI: 10.12998/wjcc.v8.i17.3821] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/22/2020] [Accepted: 08/21/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Gastrointestinal subepithelial tumors (GSTs), incidentally detected during upper gastrointestinal (GI) endoscopy, may be lesions derived from the GI wall or may be caused by compression from external organs. In general, traumatic neuroma is a benign nerve tumor that results from postoperative nerve injury, occurring in the bile duct as one of the complications after cholecystectomy. This is the first case report demonstrating that neuroma of the cystic duct can be incorrectly perceived as a duodenal subepithelial tumor by compressing the duodenal wall.
CASE SUMMARY We report the case of a 72-year-old man with traumatic neuroma of the cystic duct after cholecystectomy. This tumor was mistaken for a duodenal subepithelial tumor on preoperative upper GI endoscopy and endoscopic ultrasonography due to external compression of the GI wall. The patient had no symptoms, and his laboratory test results were normal. However, in a series of follow-up endoscopies, the tumor was found to have grown in size, so it was surgically resected. The lesion was completely removed by laparoscopic endoscopic cooperative surgery. The patient was discharged on postoperative day 7 without complications.
CONCLUSION Traumatic neuroma of the cystic duct can be mistaken for GSTs in GI endoscopy.
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Affiliation(s)
- Dong-Hwan Kim
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Ji-Ho Park
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Jin-Kyu Cho
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Jung-Wook Yang
- Department of Pathology, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Tae-Han Kim
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Sang-Ho Jeong
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Young-Hye Kim
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Young-Joon Lee
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Soon-Chan Hong
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Eun-Jung Jung
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Young-Tae Ju
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Chi-Young Jeong
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
| | - Ju-Yeon Kim
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
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Ren Z, Lin SL, Zhou PH, Cai SL, Qi ZP, Li J, Yao LQ. Endoscopic full-thickness resection (EFTR) without laparoscopic assistance for nonampullary duodenal subepithelial lesions: our clinical experience of 32 cases. Surg Endosc 2019; 33:3605-3611. [PMID: 31240477 DOI: 10.1007/s00464-018-06644-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 12/19/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Standard treatment for nonampullary duodenal tumors has not yet been established. In case of tumors originated from the muscularis propria (MP) layer and adherent to the serosa layer, the lesions can not be completely removed by ESD. However, with the development of the endoscopic suture technique, endoscopic full-thickness resection (EFTR) of duodenal subepithelial lesions has become possible. METHODS We retrospectively analyzed 32 patients with nonampullary duodenal subepithelial lesions who underwent EFTR between February 2012 and January 2017. The suturing method, complications that occurred during and after the operations, perioperative management, tumor characteristics, and pathological findings were analyzed in all patients. RESULTS The complete resection rate was 100%; all patients successfully received EFTR except for one patient who required conversion to open surgery. Severe abdominal pain was observed after the operation in one patient who then received laparoscopic exploration, and the possibility of delayed perforation was considered. Another patient showed a decline in blood oxygen saturation (SO2) and was transferred to the intensive care unit (ICU) for further management. Delayed bleeding and fistula were not observed. All patients achieved complete remission. CONCLUSION EFTR is a safe, minimally invasive treatment modality that ensures complete eradication of the duodenal subepithelial lesions.
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Affiliation(s)
- Zhong Ren
- Endoscopy Center, Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Sheng-Li Lin
- Endoscopy Center, Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Ping-Hong Zhou
- Endoscopy Center, Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
| | - Shi-Lun Cai
- Endoscopy Center, Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Zhi-Peng Qi
- Endoscopy Center, Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jian Li
- Endoscopy Center, Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Li-Qing Yao
- Endoscopy Center, Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
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Poudel S, Ebihara Y, Tanaka K, Kurashima Y, Murakami S, Shichinohe T, Hirano S. Two cases of laparoscopic direct spiral closure of large defects in the second portion of the duodenum after laparoscopic endoscopic co-operative surgery. J Minim Access Surg 2017; 14:149-153. [PMID: 29226886 PMCID: PMC5869976 DOI: 10.4103/jmas.jmas_182_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Curative endoscopic resection of non-ampullary duodenal lesions, although possible, is challenging. In recent years, although a novel surgical technique named laparoscopic-endoscopic cooperative surgery (LECS), which combines laparoscopic and endoscopic techniques, has made the resection of nonampullary duodenal lesions relatively easier, closure of the defect is still controversial. We report two cases of the duodenal lesion which were closed using a novel technique for primary closure utilising the free wall of the duodenum. Two cases of the duodenal lesion in the second portion of the duodenum were undergone full thickness resection using the LECS technique. The defect is designed spirally to ensure maximum use of the free wall of the duodenum. The mucosal layer is closed using a running suture, and the seromuscular layer is closed using interrupted sutures. The suture line is then reinforced with omentum. There were no intraoperative complications and had uneventful post-operative courses with no leakage, stenosis, or relapse.
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Affiliation(s)
- Saseem Poudel
- Department of Gastroenterological Surgery II, Hokkaido University, Graduate School of Medicine, Sapporo, Japan
| | - Yuma Ebihara
- Department of Gastroenterological Surgery II, Hokkaido University, Graduate School of Medicine, Sapporo, Japan
| | - Kimitaka Tanaka
- Department of Gastroenterological Surgery II, Hokkaido University, Graduate School of Medicine, Sapporo, Japan
| | - Yo Kurashima
- Department of Gastroenterological Surgery II, Hokkaido University, Graduate School of Medicine, Sapporo, Japan
| | - Soichi Murakami
- Department of Gastroenterological Surgery II, Hokkaido University, Graduate School of Medicine, Sapporo, Japan
| | - Toshiaki Shichinohe
- Department of Gastroenterological Surgery II, Hokkaido University, Graduate School of Medicine, Sapporo, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Hokkaido University, Graduate School of Medicine, Sapporo, Japan
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Balde AI, Chen T, Hu Y, Redondo N JD, Liu H, Gong W, Yu J, Zhen L, Li G. Safety analysis of laparoscopic endoscopic cooperative surgery versus endoscopic submucosal dissection for selected gastric gastrointestinal stromal tumors: a propensity score-matched study. Surg Endosc 2017; 31:843-851. [PMID: 27492430 DOI: 10.1007/s00464-016-5042-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 06/11/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic endoscopic cooperative surgery (LECS) is a safe alternative to endoscopic submucosal dissection (ESD) for select gastric gastrointestinal stromal tumors (GISTs) that are <2 cm in size. To date, there have been no randomized studies comparing the feasibility of these two techniques. Therefore, we compared their feasibility and safety using the propensity score matching method in this study. METHODS This was a single-center, retrospective, propensity score-matched study of patients who underwent resection of selected gastric GISTs between 2004 and 2014. All patients underwent curative resection for pathologically diagnosed small gastric GISTs. The primary aim was to determine intraoperative complications and postoperative courses. To overcome selection biases, we performed a 1:1 match using five covariates, including age, gender, body mass index, Charlson comorbidity index, and tumor location, to generate propensity scores. RESULTS In total, 32 patients treated with LECS and 102 patients treated with ESD were balanced into 30 pairs. The rate of intraoperative complications was significantly lower in the LECS group than in the ESD group (P = 0.029). LECS patients had less intraoperative bleeding than did ESD patients (15.0 ml [range 9.5-50.0 ml] vs. 43.5 ml [range 22.3-56.0 ml], P = 0.004). The two groups had similar postoperative courses. There was no difference in the reoperation rate between the two groups (P = 0.112). The ESD group had a shorter operating time than did the LECS group (41.5 min vs. 96.5 min, P < 0.001). However, during a follow-up of 57.9 (±28.9) months, the recurrence rate did not differ significantly between the two groups (0.0 vs. 6.7 %, respectively; P = 0.256). CONCLUSIONS LECS for selected gastric GIST patients is feasible and is associated with a better intraoperative outcome and an equal postoperative course compared with the results of ESD.
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Affiliation(s)
- A I Balde
- Department of General Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou, 510515, Guangdong Province, China
| | - Tao Chen
- Department of General Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou, 510515, Guangdong Province, China
| | - Yanfeng Hu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou, 510515, Guangdong Province, China
| | - J D Redondo N
- Department of General Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou, 510515, Guangdong Province, China
| | - Hao Liu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou, 510515, Guangdong Province, China
| | - Wei Gong
- Department of Digestive Endoscopy, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong Province, China
| | - Jiang Yu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou, 510515, Guangdong Province, China
| | - Li Zhen
- Department of General Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou, 510515, Guangdong Province, China.
| | - Guoxin Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, No. 1838, North Guangzhou Avenue, Guangzhou, 510515, Guangdong Province, China.
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Ichikawa D, Komatsu S, Dohi O, Naito Y, Kosuga T, Kamada K, Okamoto K, Itoh Y, Otsuji E. Laparoscopic and endoscopic co-operative surgery for non-ampullary duodenal tumors. World J Gastroenterol 2016; 22:10424-10431. [PMID: 28058023 PMCID: PMC5175255 DOI: 10.3748/wjg.v22.i47.10424] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/10/2016] [Accepted: 11/13/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the safety and feasibility of laparoscopic and endoscopic co-operative surgery (LECS) for early non-ampullary duodenal tumors.
METHODS Twelve patients with a non-ampullary duodenal tumor underwent LECS at our hospital. One patient had two mucosal lesions in the duodenum. The indication for this procedure was the presence of duodenal tumors with a low risk for lymph node metastasis. In particular, the tumors included small (less than 10 mm) submucosal tumors (SMT) and epithelial mucosal tumors, such as mucosal cancers or large mucosal adenomas with malignant suspicion. The LECS procedures, such as full-thickness dissection for SMT and laparoscopic reinforcement after endoscopic submucosal dissection (ESD) for epithelial tumors, were performed for the 13 early duodenal lesions in 12 patients. Here we present the short-term outcomes and evaluate the safety and feasibility of this new technique.
RESULTS Two SMT-like lesions and eleven superficial epithelial tumor-like lesions were observed. Seven and Six lesions were located in the second and third parts of the duodenum, respectively. All lesions were successfully resected en bloc. The defect in the duodenal wall was manually sutured after resection of the duodenal SMT. For epithelial duodenal tumors, the ulcer bed was laparoscopically reinforced via manual suturing after ESD. Intraoperative perforation occurred in two out of eleven epithelial tumor-like lesions during ESD; however, they were successfully laparoscopically repaired. The median operative time and intraoperative estimated blood loss were 322 min and 0 mL, respectively. Histological examination of the tumors revealed one adenoma with moderate atypia, ten adenocarcinomas, and two neuroendocrine tumors. No severe postoperative complications (Clavien-Dindo classification grade III or higher) were reported in this series, but minor leakage secondary to pancreatic fistula occurred in one patient.
CONCLUSION LECS can be a safe and minimally invasive treatment option for non-ampullary early duodenal tumors.
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Fujihara S, Mori H, Kobara H, Nishiyama N, Matsunaga T, Ayaki M, Yachida T, Masaki T. Management of a large mucosal defect after duodenal endoscopic resection. World J Gastroenterol 2016; 22:6595-6609. [PMID: 27547003 PMCID: PMC4970484 DOI: 10.3748/wjg.v22.i29.6595] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 05/23/2016] [Accepted: 06/15/2016] [Indexed: 02/06/2023] Open
Abstract
Duodenal endoscopic resection is the most difficult type of endoscopic treatment in the gastrointestinal tract (GI) and is technically challenging because of anatomical specificities. In addition to these technical difficulties, this procedure is associated with a significantly higher rate of complication than endoscopic treatment in other parts of the GI tract. Postoperative delayed perforation and bleeding are hazardous complications, and emergency surgical intervention is sometimes required. Therefore, it is urgently necessary to establish a management protocol for preventing serious complications. For instance, the prophylactic closure of large mucosal defects after endoscopic resection may reduce the risk of hazardous complications. However, the size of mucosal defects after endoscopic submucosal dissection (ESD) is relatively large compared with the size after endoscopic mucosal resection, making it impossible to achieve complete closure using only conventional clips. The over-the-scope clip and polyglycolic acid sheets with fibrin gel make it possible to close large mucosal defects after duodenal ESD. In addition to the combination of laparoscopic surgery and endoscopic resection, endoscopic full-thickness resection holds therapeutic potential for difficult duodenal lesions and may overcome the disadvantages of endoscopic resection in the near future. This review aims to summarize the complications and closure techniques of large mucosal defects and to highlight some directions for management after duodenal endoscopic treatment.
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Ohata K, Nonaka K, Sakai E, Minato Y, Satodate H, Watanabe K, Matsuhashi N. Novel technique of endoscopic full-thickness resection for superficial nonampullary duodenal neoplasms to avoid intraperitoneal tumor dissemination. Endosc Int Open 2016; 4:E784-7. [PMID: 27556096 PMCID: PMC4993879 DOI: 10.1055/s-0042-107666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 04/25/2016] [Indexed: 02/07/2023] Open
Abstract
Recently, laparoscopic and/or endoscopic full-thickness resection (FTR) has been reported to be a useful technique for the treatment of superficial duodenal neoplasms (SDNs). In the current study, we evaluated clinical outcomes in 5 consecutive patients who underwent resection of nonampullary SDNs using laparoscopy-assisted endoscopic full-thickness resection with ligation Device (LAEFTR-L), which is an alternative FTR method developed to avoid peritoneal dissemination. Using a snare technique with a ligation band, the duodenal lesions were easily resected. The provisional and additional sutures for the resected site prevented delayed perforation and bleeding and they also protected the abdominal cavity from direct exposure to malignant cells. Complete resection could be achieved and FTR was histologically confirmed in all cases. The mean operation time was 173 minutes (range 138 - 217 minutes). Mean diameter of the resected specimen was 24 mm (range 18 - 32 mm). No adverse events (AEs) were observed. LAEFTR-L, which can achieve complete resection of nonampullary SDNs without severe AEs and peritoneal dissemination, could be a useful technique for the treatment of such lesions.
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Affiliation(s)
- Ken Ohata
- Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan,Corresponding author Ken Ohata, MD Division of GastroenterologyNTT Medical Center Tokyo5-9-22 Higashi-gotanda, Shinagawa-ku, Tokyo, 141-8625Japan+81-3-3448-6541
| | - Kouichi Nonaka
- Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Eiji Sakai
- Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Yohei Minato
- Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
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Hybrid NOTES: Combined Laparo-endoscopic Full-thickness Resection Techniques. Gastrointest Endosc Clin N Am 2016; 26:335-373. [PMID: 27036902 DOI: 10.1016/j.giec.2015.12.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Advances in laparoscopic surgery and therapeutic endoscopy have allowed these minimally destructive procedures to challenge conventional surgery. Because of its theoretic advantages and technical feasibility, laparoendoscopic full-thickness resection is considered to be the most appropriate option for subepithelial tumor removal. Furthermore, combination of laparoscopic and endoscopic approaches for treatment of neoplasia can be important maneuvers for gastric cancer resection without contamination of the peritoneal cavity if the sentinel lymph node concept is established. We are certain that the use of laparoendoscopic full-thickness resection will provide valuable experience that will allow operators to safely develop endoscopic full-thickness resection skills.
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Kitasato A, Kuroki T, Adachi T, Tanaka T, Mine Y, Soyama A, Hidaka M, Takatsuki M, Yamaguchi N, Eguchi S. Duodenal tubular resection using laparoscopic-endoscopic cooperative surgery: A new technique for the treatment of duodenal lesions. Asian J Endosc Surg 2016; 9:101-4. [PMID: 26781540 DOI: 10.1111/ases.12207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 05/28/2015] [Accepted: 06/06/2015] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Laparoscopic-endoscopic cooperative surgery (LECS) is a minimally invasive surgical technique that combines the advantages of laparoscopic surgery and endoscopic treatment. LECS has been developed for treatment of gastric submucosal tumors and can be applied to superficial non-ampullary duodenal tumors. Here we describe the use of LECS for duodenal mucosal cancer. MATERIALS AND SURGICAL TECHNIQUE After the placement of five ports, an endoscopic procedure was performed to confirm the tumor location and to place marks around the tumor. The jejunum was then resected 10 cm from the ligament of Treitz, and the connective tissue between the pancreas and duodenum was dissected to close to Vater's papilla. Duodenal resection was performed with a stapling device 2 cm to the oral side of the tumor, with endoscopic confirmation of the duodenal papilla, and duodenal tubular resection was then accomplished. Duodeno-jejunostomy was carried out using the same stapling device. There were no postoperative complications. DISCUSSION This case shows that duodenal tubular resection using LECS enables curability through a minimally invasive procedure that offers the advantages of laparoscopic surgery and endoscopic treatment. This technique is applicable to duodenal lesions such as those due to duodenal mucosal cancers.
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Affiliation(s)
- Amane Kitasato
- Department of Surgery, Nagasaki University, Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tamotsu Kuroki
- Department of Surgery, Nagasaki University, Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomohiko Adachi
- Department of Surgery, Nagasaki University, Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takayuki Tanaka
- Department of Surgery, Nagasaki University, Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yuka Mine
- Department of Surgery, Nagasaki University, Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Akihiko Soyama
- Department of Surgery, Nagasaki University, Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masaaki Hidaka
- Department of Surgery, Nagasaki University, Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Mitsuhisa Takatsuki
- Department of Surgery, Nagasaki University, Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Naoyuki Yamaguchi
- Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University, Graduate School of Biomedical Sciences, Nagasaki, Japan
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Lim CH, Cho YS. Nonampullary duodenal adenoma: Current understanding of its diagnosis, pathogenesis, and clinical management. World J Gastroenterol 2016; 22:853-861. [PMID: 26811631 PMCID: PMC4716083 DOI: 10.3748/wjg.v22.i2.853] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 08/10/2015] [Accepted: 10/23/2015] [Indexed: 02/06/2023] Open
Abstract
Nonampullary duodenal adenomas are relatively common in familial adenomatous polyposis (FAP), but nonampullary sporadic duodenal adenomas (SDAs) are rare. Emerging evidence shows that duodenal adenomas, regardless of their anatomic location and whether they are sporadic or FAP-related, share morphologic and molecular features with colorectal adenomas. The available data suggest that duodenal adenomas develop to duodenal adenocarcinomas via similar mechanisms. The optimal approach for management of duodenal adenomas remains to be determined. The techniques for endoscopic resection of duodenal adenoma include snare polypectomy, endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and argon plasma coagulation ablation. EMR may facilitate removal of large duodenal polyps. Although several studies have reported cases of successful ESD for duodenal adenomas, the procedure is technically difficult to perform safely because of the anatomical properties of the duodenum. Although current clinical practice recommends endoscopic resection of all large duodenal adenomas in patients with FAP, endoscopic treatment is usually insufficient to guarantee a polyp-free duodenum. Surgery is indicated for FAP patients with severe polyposis or nonampullary SDAs or FAP-related polyps not amenable to endoscopic resection. Further studies are needed to develop newer endoscopic techniques to guide diagnostic and therapeutic decisions for future management of nonampullary duodenal adenomas.
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Cai SL, Shi Q, Chen T, Zhong YS, Yao LQ. Endoscopic resection of tumors in the lower digestive tract. World J Gastrointest Endosc 2015; 7:1238-1242. [PMID: 26634039 PMCID: PMC4658603 DOI: 10.4253/wjge.v7.i17.1238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 06/22/2015] [Accepted: 09/07/2015] [Indexed: 02/05/2023] Open
Abstract
As endoscopic technology has developed and matured, the endoscopic resection of gastrointestinal tract polyps has become a widely used treatment. Colorectal polyps are the most common type of polyp, which are best managed by early resection before the polyp undergoes malignant transformation. Methods for treating colorectal tumors are numerous, including argon plasma coagulation, endoscopic mucosal resection, endoscopic submucosal dissection, and laparoscopic-endoscopic cooperative surgery. In this review, we will highlight several currently used clinical endoscopic resection methods and how they are selected based on the characteristics of the targeted tumor. Specifically, we will focus on laparoscopic-endoscopic cooperative surgery.
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Abe N, Takeuchi H, Hashimoto Y, Yoshimoto E, Kojima Y, Ohki A, Nagao G, Suzuki Y, Horiai S, Mizuno H, Masaki T, Mori T, Sugiyama M. Laparoscopy-assisted transduodenal excision of superficial non-ampullary duodenal epithelial tumors. Asian J Endosc Surg 2015; 8:310-5. [PMID: 25950619 DOI: 10.1111/ases.12191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 03/09/2015] [Accepted: 03/19/2015] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Transduodenal excision (transduodenal submucosal dissection) is an alternative to pancreaticoduodenectomy for the treatment of benign and low-grade malignant tumors of the duodenum. However, laparoscopic transduodenal excision or laparoscopy-assisted transduodenal excision (LATDE) of such tumors has been rarely reported. In this paper, we present the preliminary results of LATDE in patients with superficial non-ampullary duodenal epithelial tumors. METHODS Three patients with superficial non-ampullary duodenal epithelial tumors (mucosal adenocarcinoma, n = 1; tubular adenoma, n = 2) underwent LATDE. LATDE consists of four major procedures: (i) laparoscopic wide Kocher maneuver (mobilization of the pancreaticoduodenum); (ii) extracorporeal approach to the fully mobilized duodenum through the upper median longitudinal incision (4 cm in length); (iii) tumor excision by submucosal dissection under direct vision through longitudinal duodenotomy (4 cm in length); and (iv) hand-sewn closure of the mucosal defect and duodenotomy. RESULTS LATDE was successfully carried out without any intraoperative or postoperative adverse events. The mean operating time and estimated blood loss were 155 min and 17 mL, respectively. Contrast roentgenography on postoperative day 4 showed neither duodenal deformity nor disturbance of gastroduodenal emptying in any of the patients. CONCLUSIONS LATDE could eliminate the possibility of peritoneal or port-site seeding of tumor cells because the duodenotomy and tumor excision are performed extracorporeally. The meticulously hand-sewn closures of the mucosal defect and duodenotomy can minimize the possibility of postoperative hemorrhage and/or anastomotic leakage. LATDE is a feasible, safe, and minimally invasive treatment for patients with superficial non-ampullary duodenal epithelial tumors that have no risk of lymph node metastasis in the first and second portions of the duodenum.
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Affiliation(s)
- Nobutsugu Abe
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Hirohisa Takeuchi
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | | | - Eri Yoshimoto
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Youhei Kojima
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Atsuko Ohki
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Gen Nagao
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Yutaka Suzuki
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Shinichi Horiai
- Department of Surgery, Mejiro Second General Hospital, Tokyo, Japan
| | - Hideaki Mizuno
- Department of Surgery, Mejiro Second General Hospital, Tokyo, Japan
| | - Tadahiko Masaki
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Toshiyuki Mori
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Masanori Sugiyama
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
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Folkert IW, Roses RE. Endoscopic full-thickness resection with laparoscopic assistance. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2015. [DOI: 10.1016/j.tgie.2015.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Tamaki I, Obama K, Matsuo K, Kami K, Uemoto Y, Sato T, Ito T, Tamaki N, Kubota K, Inoue H, Yamamoto E, Morimoto T. A case of primary adenocarcinoma of the third portion of the duodenum resected by laparoscopic and endoscopic cooperating surgery. Int J Surg Case Rep 2015; 9:34-8. [PMID: 25723745 PMCID: PMC4392333 DOI: 10.1016/j.ijscr.2015.02.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 02/18/2015] [Indexed: 02/07/2023] Open
Abstract
Laparoscopic and endoscopic cooperating surgery (LECS) enabled en bloc resection with adequate surgical margins and secure intra-abdominal suturing for duodenal neoplasms. Thorough mobilization of the mesocolon and pancreas head is essential for this procedure because it facilitates correct resection and suturing. LECS is a feasible treatment option for duodenal neoplasms. Introduction We report a case of primary adenocarcinoma in the third portion of the duodenum (D3) curatively resected by laparoscopic and endoscopic cooperating surgery (LECS). Presentation of case A 65-year-old woman had a routine visit to our hospital for a follow-up of rectal cancer resected curatively 2 years ago. A routine screening gastroduodenal endoscopy revealed an elevated lesion of 20 mm in diameter in the D3. The preoperative diagnosis was adenoma with high-grade dysplasia; however, suspicion about potential adenocarcinoma was undeniable. Curative resection was performed by LECS. Pathological examination revealed intramucosal adenocarcinoma arising from normal duodenal mucosa. The tumor was stage I (T1/N0/M0) in terms of the tumor, nodes, metastasis (TNM) classification. LECS for duodenal tumor has seldom been reported previously, and this is the first report of LECS for primary adenocarcinoma in the D3. The transverse mesocolon was removed from the head of pancreas to expose the duodenum, and the accessory right colic vein was cut; this was followed by the Kocher maneuver for mobilization of the lesion site. Discussion LECS enabled en bloc resection with adequate surgical margins and secure intra-abdominal suturing. Thorough mobilization of the mesocolon and pancreas head is essential for this procedure because it facilitates correct resection and suturing. Conclusion LECS is a feasible treatment option for duodenal neoplasms, including intramucosal adenocarcinoma, even though it exists in the D3.
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Affiliation(s)
- Ichiro Tamaki
- Kyoto City Hospital, Department of Surgery, Mibuhigashitakadacho 1-2, Nakagyo Ward, Kyoto City, Kyoto Pref., Japan.
| | - Kazutaka Obama
- Kyoto City Hospital, Department of Surgery, Mibuhigashitakadacho 1-2, Nakagyo Ward, Kyoto City, Kyoto Pref., Japan
| | - Koichi Matsuo
- Kyoto City Hospital, Department of Surgery, Mibuhigashitakadacho 1-2, Nakagyo Ward, Kyoto City, Kyoto Pref., Japan
| | - Kazuhiro Kami
- Kyoto City Hospital, Department of Surgery, Mibuhigashitakadacho 1-2, Nakagyo Ward, Kyoto City, Kyoto Pref., Japan
| | - Yusuke Uemoto
- Kyoto City Hospital, Department of Surgery, Mibuhigashitakadacho 1-2, Nakagyo Ward, Kyoto City, Kyoto Pref., Japan
| | - Teruyuki Sato
- Kyoto City Hospital, Department of Surgery, Mibuhigashitakadacho 1-2, Nakagyo Ward, Kyoto City, Kyoto Pref., Japan
| | - Tetsuo Ito
- Kyoto City Hospital, Department of Surgery, Mibuhigashitakadacho 1-2, Nakagyo Ward, Kyoto City, Kyoto Pref., Japan
| | - Nobuyuki Tamaki
- Kyoto City Hospital, Department of Surgery, Mibuhigashitakadacho 1-2, Nakagyo Ward, Kyoto City, Kyoto Pref., Japan
| | - Keiko Kubota
- Kyoto City Hospital, Department of Surgery, Mibuhigashitakadacho 1-2, Nakagyo Ward, Kyoto City, Kyoto Pref., Japan
| | - Hidenobu Inoue
- Kyoto City Hospital, Department of Surgery, Mibuhigashitakadacho 1-2, Nakagyo Ward, Kyoto City, Kyoto Pref., Japan
| | - Eiji Yamamoto
- Kyoto City Hospital, Department of Surgery, Mibuhigashitakadacho 1-2, Nakagyo Ward, Kyoto City, Kyoto Pref., Japan
| | - Taisuke Morimoto
- Kyoto City Hospital, Department of Surgery, Mibuhigashitakadacho 1-2, Nakagyo Ward, Kyoto City, Kyoto Pref., Japan
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Tsushimi T, Mori H, Harada T, Nagase T, Iked Y, Ohnishi H. Laparoscopic and endoscopic cooperative surgery for duodenal neuroendocrine tumor (NET) G1: Report of a case. Int J Surg Case Rep 2014; 5:1021-4. [PMID: 25460463 PMCID: PMC4275848 DOI: 10.1016/j.ijscr.2014.10.051] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 10/13/2014] [Accepted: 10/14/2014] [Indexed: 12/17/2022] Open
Abstract
Endoscopic treatment is generally recommended for G1 NETs <10 mm in diameter and extending only to the submucosal layer in gastrointestinal tract. Some cases are difficult to resect endoscopically in duodenal tumor because the wall is thinner than that of stomach, and endoscope maneuverability is limited within the narrow working space. We resected duodenal NET G1 using LECS technique and we demonstrated that LECS is a safe and feasible procedure for duodenal G1 NETs. INTRODUCTION We report a case of duodenal neuroendocrine tumor (NET) G1 resected by laparoscopic and endoscopic cooperative surgery (LECS) technique. PRESENTATION OF CASE A 58-year-old woman underwent esophagastroduodenoscopy, revealing an 8-mm, gently rising tumor distal to the pylorus, on the anterior wall of the duodenal bulb. Endoscopic ultrasonography suggested the tumor might invade the submucosal layer. The tumor was pathologically diagnosed as a G1 duodenal NET, by biopsy. Endoscopic submucosal dissection was attempted, but was unsuccessful because of the difficulty of endoscopically performing an inversion operation in the narrow working space. The case was further complicated by the patient's duodenal ulcer scar. We performed a full-thickness local excision using laparoscopic and endoscopic cooperative surgery. The tumor was confirmed and endoscopically marked along the resection line. After full-thickness excision, using endoscopy and laparoscopy, interrupted full-thickness closure was performed laparoscopically. DISCUSSION Endoscopic treatment is generally recommended for G1 NETs <10 mm in diameter and extending only to the submucosal layer. However, some cases are difficult to resect endoscopically because the wall of duodenum is thinner than that of stomach, and endoscope maneuverability is limited within the narrow working space. LECS is appropriate for early duodenal G1 NETs because they are less invasive and resection of the lesion area is possible. CONCLUSION We demonstrated that LECS is a safe and feasible procedure for duodenal G1 NETs in the anterior wall of the first portion of the duodenum.
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Affiliation(s)
- Takaaki Tsushimi
- Ehime Rosai Hospital, Department of Surgery, Minamikomatsubara-cho 13-27, Niihama, Ehime 792-8550, Japan.
| | - Hirohito Mori
- Ehime Rosai Hospital, Department of Surgery, Minamikomatsubara-cho 13-27, Niihama, Ehime 792-8550, Japan
| | - Takasuke Harada
- Ehime Rosai Hospital, Department of Surgery, Minamikomatsubara-cho 13-27, Niihama, Ehime 792-8550, Japan
| | - Takashi Nagase
- Ehime Rosai Hospital, Department of Surgery, Minamikomatsubara-cho 13-27, Niihama, Ehime 792-8550, Japan
| | - Yoshitaka Iked
- Ehime Rosai Hospital, Department of Surgery, Minamikomatsubara-cho 13-27, Niihama, Ehime 792-8550, Japan
| | - Hiromo Ohnishi
- Ehime Rosai Hospital, Department of Pathology, Minamikomatsubara-cho 13-27, Niihama, Ehime 792-8550, Japan
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Kakushima N, Kanemoto H, Tanaka M, Takizawa K, Ono H. Treatment for superficial non-ampullary duodenal epithelial tumors. World J Gastroenterol 2014; 20:12501-12508. [PMID: 25253950 PMCID: PMC4168083 DOI: 10.3748/wjg.v20.i35.12501] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 04/18/2014] [Accepted: 05/19/2014] [Indexed: 02/06/2023] Open
Abstract
Because of the low prevalence of non-ampullary duodenal epithelial tumors (NADETs), standardized clinical management of sporadic superficial NADETs, including diagnosis, treatment, and follow-up, has not yet been established. Retrospective studies have revealed certain endoscopic findings suggestive of malignancy. Duodenal adenoma with high-grade dysplasia and mucosal cancer are candidates for local resection by endoscopic or minimally invasive surgery. The use of endoscopic treatment including endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), for the treatment for superficial NADETs is increasing. EMR requires multiple sessions to achieve complete remission and repetitive endoscopy is needed after resection. ESD provides an excellent complete resection rate, however it remains a challenging method, considering the high risk of intraoperative or delayed perforation. Minimally invasive surgery such as wedge resection and pancreas-sparing duodenectomy are beneficial for superficial NADETs that are technically difficult to remove by endoscopic treatment. Pancreaticoduodenectomy remains a standard surgical procedure for treatment of duodenal cancer with submucosal invasion, which presents a risk of lymph node metastasis. Endoscopic or surgical treatment outcomes of superficial NADETs without submucosal invasion are satisfactory. Establishing an endoscopic diagnostic tool to differentiate superficial NADETs between adenoma and cancer as well as between mucosal and submucosal cancer is required to select the most appropriate treatment.
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Abe N, Suzuki Y, Masaki T, Mori T, Sugiyama M. Surgical management of superficial non-ampullary duodenal tumors. Dig Endosc 2014; 26 Suppl 2:57-63. [PMID: 24750150 DOI: 10.1111/den.12272] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 01/29/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM We present our experiences with the so-called 'limited resections' such as transduodenal excision and local full-thickness resection for superficial non-ampullary duodenal tumors (SNADT). The optimal surgical management for SNADT is also discussed. METHODS Six patients with SNADT (adenoma, n=1; mucosal carcinomas, n=2; submucosal carcinoma, n=1; carcinoids, n=2) were included in this study. Four patients underwent transduodenal excision, one local full-thickness resection, and one laparoscopy-assisted endoscopic full-thickness resection as a modification of local full-thickness resection. RESULTS All patients were successfully treated by these limited resections without any adverse events. CONCLUSIONS Surgical resection is the treatment of choice for SNADT not amenable to endoscopic resection in terms of technical and/or oncological reasons. However, the optimal surgical management for SNADT remains controversial because of the complexity of the relevant anatomy of the duodenum, its rarity, the not well-known incidence of nodal metastasis, and the wide spectrum of pathologies that can be encountered.
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Affiliation(s)
- Nobutsugu Abe
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
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Goda K, Kikuchi D, Yamamoto Y, Takimoto K, Kakushima N, Morita Y, Doyama H, Gotoda T, Maehata Y, Abe N. Endoscopic diagnosis of superficial non-ampullary duodenal epithelial tumors in Japan: Multicenter case series. Dig Endosc 2014; 26 Suppl 2:23-9. [PMID: 24750144 DOI: 10.1111/den.12277] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 02/06/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM To verify the current status in Japan on endoscopic diagnosis of superficial non-ampullary duodenal epithelial tumors (SNADET) by a multicenter case series through a questionnaire survey. METHODS Nine endoscopists and a surgeon responded to a questionnaire on endoscopic diagnosis of SNADET. The subjects of this survey were histologically confirmed SNADET that were endoscopically or surgically resected from 2007 to 2012. This survey collected data of 364 patients with 396 SNADET. RESULTS Of the 396 SNADET, 121 were histologically diagnosed as low-grade dysplasia (LGD), 112 as high-grade dysplasia (HGD), and 163 as superficial adenocarcinoma (SAC) including 153 mucosal carcinomas and 10 submucosal carcinomas. Total number of SNADET increased from 125 in the first half to 271 in the second half of the survey period. Compared to LGD, a significantly greater number of HGD or SAC was found in the tumors having a diameter >5 mm as well as solitary or predominantly red color. Preoperative endoscopic diagnosis indicated significantly higher sensitivity and accuracy and significantly lower specificity for HGD or SAC of final histology than preoperative biopsy. Ten submucosal carcinomas had 0-I or 0-IIa+IIc macroscopic-type tumors with red color. CONCLUSIONS This multicenter case series study suggested that the number of resected SNADET is dramatically increasing in Japan. Tumor diameter >5 mm and red color seemed to be signs for tumors of HGD or SAC. Preoperative endoscopy may provide a more reliable diagnosis of final histology of HGD or SAC than preoperative biopsy. Further studies are warranted for establishing endoscopic features of submucosal carcinoma.
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Affiliation(s)
- Kenichi Goda
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
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Feasibility of endoscopy-assisted laparoscopic full-thickness resection for superficial duodenal neoplasms. ScientificWorldJournal 2014; 2014:239627. [PMID: 24550694 PMCID: PMC3914555 DOI: 10.1155/2014/239627] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 10/29/2013] [Indexed: 02/06/2023] Open
Abstract
Background. Superficial duodenal neoplasms (SDNs) are a challenging target in the digestive tract. Surgical resection is invasive, and it is difficult to determine the site and extent of the lesion from outside the intestine and resect it locally. Endoscopic submucosal dissection (ESD) has scarcely been utilized in the treatment of duodenal tumors because of technical difficulties and possible delayed perforation due to the action of digestive juices. Thus, no standard treatments for SDNs have been established. To challenge this issue, we elaborated endoscopy-assisted laparoscopic full-thickness resection (EALFTR) and analyzed its feasibility and safety. Methods. Twenty-four SDNs in 22 consecutive patients treated by EALFTR between January 2011 and July 2012 were analyzed retrospectively. Results. All lesions were removed en bloc. The lateral and vertical margins of the specimens were negative for tumor cells in all cases. The mean sizes of the resected specimens and lesions were 28.9 mm (SD ± 10.5) and 13.3 mm (SD ± 11.6), respectively. The mean operation time and intraoperative estimated blood loss were 133 min (SD ± 45.2) and 16 ml (SD ± 21.1), respectively. Anastomotic leakage occurred in three patients (13.6%) postoperatively, but all were minor leakage and recovered conservatively. Anastomotic stenosis or bleeding did not occur. Conclusions. EALFTR can be a safe and minimally invasive treatment option for SDNs. However, the number of cases in this study was small, and further accumulations of cases and investigation are necessary.
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Ohi M, Yasuda H, Ishino Y, Katsurahara M, Saigusa S, Tanaka K, Tanaka K, Mohri Y, Inoue Y, Uchida K, Kusunoki M. Single-incision laparoscopic and endoscopic cooperative surgery for gastrointestinal stromal tumor arising from the duodenum. Asian J Endosc Surg 2013; 6:307-10. [PMID: 24308591 DOI: 10.1111/ases.12059] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Revised: 05/18/2013] [Accepted: 07/29/2013] [Indexed: 02/06/2023]
Abstract
We report a case involving a minimally invasive single-incision laparoscopic and endoscopic cooperative local excision of a duodenal gastrointestinal stromal tumor. A 59-year-old man presented with a 35-mm lesion located in the second portion of the duodenum. A local resection was performed via single-incision laparoscopic and endoscopic cooperative surgery. Intraluminal endoscopic dissection of the duodenal mucosa and submucosa was performed circumferentially around the tumor. The resection was then completed by laparoscopic dissection of the seromuscular layer around the tumor. The tumor was retrieved laparoscopically. After confirming that the resection achieved clear surgical margins, we closed the duodenal wall with a laparoscopic stapling device. There were no postoperative complications, including stenosis. Single-incision laparoscopic and endoscopic cooperative surgery can be safely and effectively performed for a duodenal submucosal tumor.
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Affiliation(s)
- Masaki Ohi
- Department of Innovative Surgery, Mie University Graduate School of Medicine, Tsu, Japan
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Abe N, Takeuchi H, Ooki A, Nagao G, Masaki T, Mori T, Sugiyama M. Recent developments in gastric endoscopic submucosal dissection: towards the era of endoscopic resection of layers deeper than the submucosa. Dig Endosc 2013; 25 Suppl 1:64-70. [PMID: 23368096 DOI: 10.1111/j.1443-1661.2012.01387.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Accepted: 08/20/2012] [Indexed: 12/11/2022]
Abstract
With technical advances in endoscopic submucosal dissection (ESD), several variations of endoscopic procedure derived from ESD and fusion procedures of endoscopy and laparoscopy for upper gastrointestinal submucosal tumor and cancer have recently been developed. The former includes endoscopic muscularis dissection (EMD), submucosal endoscopic tumor resection (SET), endoscopic submucosal tunnel dissection (ESTD) and endoscopic full-thickness resection (EFTR), and the latter includes laparoscopic and endoscopic cooperative surgery (LECS), laparoscopy-assisted endoscopic full-thickness resection (LAEFR), and laparoscopic lymphadenectomy without gastrectomy following ESD. In the present article, recent developments in gastric ESD and advanced procedures derived from ESD are discussed.
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Affiliation(s)
- Nobutsugu Abe
- The Department of Surgery, Kyorin University School of Medicine, Mitaka, Tokyo, Japan.
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Hadjittofi C, Parisinos CA, Somri M, Matter I. Totally laparoscopic resection of a rare duodenal tumour. BMJ Case Rep 2012; 2012:bcr.02.2012.5860. [PMID: 22669863 DOI: 10.1136/bcr.02.2012.5860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
A 39-year-old woman presented to the gastroenterology clinic with recurrent right-upper-quadrant pain and elevated liver enzymes. Endoscopy revealed a small submucosal mass at the edge of the major duodenal papilla, which was not amenable to endoscopic resection. The mass was successfully resected by laparoscopy. The papilla was subsequently reconstructed and a cannula inserted in the common bile duct. The postoperative period was uneventful and the patient was discharged on the third postoperative day. Subsequent pathological examination of the excised mass revealed a gangliocytic paraganglioma. Six weeks later, the patient was free of symptoms and the cannula was removed by duodenoscopy.
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Abe N, Takeuchi H, Shibuya M, Ohki A, Yanagida O, Masaki T, Mori T, Sugiyama M. Successful treatment of duodenal carcinoid tumor by laparoscopy-assisted endoscopic full-thickness resection with lymphadenectomy. Asian J Endosc Surg 2012; 5:81-5. [PMID: 22776369 DOI: 10.1111/j.1758-5910.2011.00120.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Reports on endoscopic full-thickness resection of the duodenum using the endoscopic submucosal dissection technique are rare. Here we present a case of a duodenal bulb carcinoid tumor successfully treated by laparoscopy-assisted endoscopic full-thickness resection (LAEFR). An asymptomatic 65-year-old woman had a 10-mm, submucosal tumor on the anterior wall of the duodenal bulb. Abdominal CT revealed an enlarged lymph node adjacent to the duodenum and pancreas. Although we informed the patient of the need for pancreatoduodenectomy with a lymphadenectomy, the patient expressly requested LAEFR. After negative nodal metastasis was confirmed by an intraoperative frozen section of the enlarged nodes, LAEFR was performed using the endoscopic submucosal dissection technique under the laparoscopic assistance. The duodenal wall defect was closed by laparoscopy with an Albert anastomosis. The entire circumferential margin of the specimen was histopathologically negative for carcinoid tumor cells. In summary, LAEFR enables en bloc and whole-layer excision of nonperiampullary duodenal lesions with a sufficient surgical margin, both vertically and laterally. LAEFR is a minimally invasive and effective treatment for selected patients with duodenal carcinoid tumor.
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Affiliation(s)
- N Abe
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan.
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