The endoluminal management of duodenal lesions

Benign duodenal lesions such as adenomas and webs have traditionally been approached endoscopically. Unfortunately, endoscopic polypectomies are limited by the size and villous nature of the lesions as well as their locations within the lumen. Duodenal web resections may be restricted by the size of the opening leading to inadequate lumen size and recurrence. When these procedures fail, conventional open or laparoscopic surgery with its attendant morbidity is often necessary. Recent advances in camera optics and mini-Iaparoscopic instrumentation have expanded the laparoscopic options available to treat mucosal and submucosal lesions of the upper GI tract. Laparoscopic endoluminal surgery has evolved into a viable option for the treatment of many intragastric lesions. We have successfully extrapolated this concept to the treatment of proximal duodenal lesions. Successful resection of a duodenal web and a large tubulovillous adenoma are presented. Laparoendoscopic intraluminal management of benign duodenal lesions is safe, feasible, and effective.