Año 2022 / Volumen 114 / Número 6
Original
Endoscopic resection in combination with ligation for the treatment of duodenal subepithelial lesions: a single-center experience

343-347

DOI: 10.17235/reed.2021.8105/2021

De-feng Li, Rui-yue Shi, Feng Xiong, Hai-yang Zhang, Ting-ting Liu, Yan-hui Tian, Zheng-lei Xu, Ben-hua Wu, Ding-guo Zhang, Jun Yao, Li-sheng Wang,

Resumen
Introduction and aim: duodenal subepithelial lesions (SELs) are increasingly detected during endoscopic examinations. However, no feasible and safe methods are available to remove duodenal SELs. The present study aimed to assess the feasibility and safety of endoscopic resection in combination with ligation (ER-L) for the removal of duodenal SELs. Patients and methods: a total of 101 patients with duodenal SELs underwent ER-L from February 2010 to February 2020. The primary outcomes were complete resection, en bloc resection and R0 resection. The secondary outcomes included procedure duration, bleeding, perforation and residual lesions. A total of 101 patients with 101 duodenal SELs (ranged from 8.4 mm to 20.2 mm in size) were included in the study. Results: most of the SELs (95.1 %) originated from the submucosal layer and were successfully removed using ER-L. The rates of complete resection, en bloc resection and R0 resection were 100 %, 96.0 % and 88.1 %, respectively. The median procedure duration was eight minutes. There were no severe complications, except for four patients who developed post-procedure bleeding (4.0 %) and recovered after conservative treatment. Furthermore, no residual lesions were detected during the follow-up period (median of 36 months). In fact, logistic regression analysis showed that the size of duodenal SELs was an independent factor for R0 resection during the ER-L procedure. Conclusion: in conclusion, ER-L is feasible and safe to remove duodenal SELs that originate from the submucosal layer and are less than 20 mm. However, the feasibility and safety of the ER-L should be further confirmed when removing the duodenal SELs that originate from the muscularis propria (MP) layer and are larger than 20 mm in diameter.
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Bibliografía
1. Humphris JL, Jones DB. Subepithelial mass lesions in the upper gastrointestinal tract. J Gastroenterol Hepatol 2008;23:556-66.
2. Matsumoto S, Miyatani H, Yoshida Y. Endoscopic submucosal dissection for duodenal tumors: a single-center experience. Endoscopy 2013;45:136-7.
3. Musumba C, Sonson R, Tutticci N, et al. Endoscopic submucosal dissection of a duodenal neuroendocrine tumor. Gastrointest Endosc 2014;79:716.
4. Miettinen M, Lasota J. Gastrointestinal stromal tumors: pathology and prognosis at different sites. Semin Diagn Pathol 2006;23:70-83.
5. Cho JW, Korean ESDSG. Current Guidelines in the Management of Upper Gastrointestinal Subepithelial Tumors. Clin Endosc 2016;49:235-40.
6. Meesters B, Pauwels PA, Pijnenburg AM, et al. Metastasis in a benign duodenal stromal tumour. Eur J Surg Oncol 1998;24:334-5.
7. Fletcher CD, Berman JJ, Corless C, et al. Diagnosis of gastrointestinal stromal tumors: A consensus approach. Hum Pathol 2002;33:459-65.
8. Seo JY, Hong SJ, Han JP, et al. Usefulness and safety of endoscopic treatment for nonampullary duodenal adenoma and adenocarcinoma. J Gastroenterol Hepatol 2014;29:1692-8.
9. Gaspar JP, Stelow EB, Wang AY. Approach to the endoscopic resection of duodenal lesions. World J Gastroenterol 2016;22:600-17.
10. Gincul R, Ponchon T, Napoleon B, et al. Endoscopic treatment of sporadic small duodenal and ampullary neuroendocrine tumors. Endoscopy 2016;48:979-986.
11. Kim TW, Kim GH, Park DY, et al. Endoscopic resection for duodenal subepithelial tumors: a single-center experience. Surg Endosc 2017;31:1936-1946.
12. Basford P, Bhandari P. Endoscopic resection of sporadic duodenal neuroendocrine tumors: Why is this not so easy? Endoscopy 2016;48:965-966.
13. Chok AY, Koh YX, Ow MY, et al. A systematic review and meta-analysis comparing pancreaticoduodenectomy versus limited resection for duodenal gastrointestinal stromal tumors. Ann Surg Oncol 2014;21:3429-38.
14. Yang F, Jin C, Du Z, et al. Duodenal gastrointestinal stromal tumor: clinicopathological characteristics, surgical outcomes, long term survival and predictors for adverse outcomes. Am J Surg 2013;206:360-7.
15. Ye LP, Mao XL, Zheng HH, et al. Safety of endoscopic resection for duodenal subepithelial lesions with wound closure using clips and an endoloop: an analysis of 68 cases. Surg Endosc 2017;31:1070-1077.
16. Lepilliez V, Chemaly M, Ponchon T, et al. Endoscopic resection of sporadic duodenal adenomas: an efficient technique with a substantial risk of delayed bleeding. Endoscopy 2008;40:806-10.
17. Bourke MJ. Endoscopic resection in the duodenum: current limitations and future directions. Endoscopy 2013;45:127-32.
18. Yamamoto H, Miura Y. Duodenal ESD: conquering difficulties. Gastrointest Endosc Clin N Am 2014;24:235-44.
19. Ren Z, Lin SL, Zhou PH, et al. 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.
20. Kappelle WFW, Backes Y, Valk GD, et al. Endoscopic full-thickness resection of gastric and duodenal subepithelial lesions using a new, flat-based over-the-scope clip. Surg Endosc 2018;32:2839-2846.
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Li D, Shi R, Xiong F, Zhang H, Liu T, Tian Y, et all. Endoscopic resection in combination with ligation for the treatment of duodenal subepithelial lesions: a single-center experience. 8105/2021


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Recibido: 16/05/2021

Aceptado: 17/09/2021

Prepublicado: 27/09/2021

Publicado: 07/06/2022

Tiempo de revisión del artículo: 122 días

Tiempo de prepublicación: 134 días

Tiempo de edición del artículo: 387 días


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