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Duodenal endoscopic submucosal dissection is feasible using the pocket-creation method.
Yoshimasa Miura1, Satoshi Shinozaki1, Yoshikazu Hayashi1
1Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
Endoscopy
|November 23, 2016
Summary
The pocket-creation method (PCM) for duodenal endoscopic submucosal dissection (ESD) is safer and more effective than conventional methods. This technique reduces perforation rates, improving outcomes for duodenal tumor removal.
Area of Science:
- Gastroenterology
- Endoscopic Surgery
- Oncology
Background:
- Duodenal endoscopic submucosal dissection (ESD) presents challenges due to a high perforation risk.
- The pocket-creation method (PCM) was developed to improve duodenal ESD techniques.
Purpose of the Study:
- To evaluate the safety and efficacy of the PCM for duodenal ESD.
- To compare PCM-assisted ESD with the conventional method for superficial duodenal tumors.
Main Methods:
- Retrospective review of 45 duodenal lesions treated with ESD (17 conventional, 28 PCM) between 2006 and 2015.
- Comparison of perforation rates, resection characteristics, and procedure efficiency between the two methods.
- Median follow-up of 35 months.
Main Results:
- PCM group had more lesions at duodenal angles (54% vs. 22%) and larger resected specimen diameters (median 37mm vs. 25mm).
- Perforation rates were significantly lower with PCM (7% vs. 29%).
- En bloc resection was more frequent with PCM (100% vs. 88%), with faster dissection speeds.
Conclusions:
- Duodenal ESD using the PCM is a safe and effective technique.
- The PCM stabilizes the endoscope, facilitating dissection in challenging locations and reducing complications.
