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Endoscopic submucosal dissection for duodenal tumors.
Kotaro Shibagaki1, Norihisa Ishimura1, Yoshikazu Kinoshita1
1Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan.
Annals of Translational Medicine
|June 16, 2017
Summary
Endoscopic submucosal dissection (ESD) for duodenal tumors offers better recurrence prevention but faces challenges like perforation. Techniques such as prophylactic closure and cooperative surgery aim to improve safety for this advanced endoscopic procedure.
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
- Endoscopic Procedures
Background:
- Endoscopic submucosal dissection (ESD) is increasingly used for duodenal tumors.
- ESD presents feasibility and safety challenges compared to endoscopic mucosal resection (EMR).
- High rates of duodenal perforation and need for emergency surgery are significant concerns.
Purpose of the Study:
- To evaluate the effectiveness and safety of ESD for duodenal tumors.
- To identify and assess methods for overcoming complications associated with duodenal ESD.
- To provide guidance on appropriate indications for duodenal ESD.
Main Methods:
- Review of current literature on duodenal ESD procedures.
- Analysis of reported complications, including perforation rates.
- Evaluation of prophylactic measures like clipping devices and polyglycolic acid sheets.
- Assessment of laparoscopic and endoscopic cooperative surgery approaches.
Main Results:
- Duodenal ESD shows potential for reduced local recurrence post-treatment.
- Significant risks of duodenal perforation and emergency surgical rescue persist.
- Prophylactic interventions can mitigate some of the risks associated with duodenal ESD.
- The procedure still requires significant refinement for widespread safe adoption.
Conclusions:
- Duodenal ESD is a promising but challenging technique for tumor treatment.
- Careful patient selection and consideration of potential complications are crucial.
- Further improvements in ESD techniques and safety measures are needed.
