Endoscopic resection of non-ampullary duodenal adenomas: Is cold snaring the promised land?

Due to the high risk of morbidity and mortality associated with surgical resection in this tract,endoscopic resection(ER)has taken the place of surgical resection as the first line treatment for non-ampullary duodenal adenomas.However,due to the anatomical characteristics of this area,which enhance the risk of post-ER problems,ER in the duodenum is particularly difficult.Due to a lack of data,no ER technique for superficial non-ampullary duodenal epithelial tumours(SNADETs)has yet been backed by strong,high-quality evidence;yet,traditional hot snare-based techniques are still regarded as the standard treatment.Despite having a favourable efficiency profile,adverse events during duodenal hot snare polypectomy(HSP)and hot endoscopic mucosal resection,such as delayed bleeding and perforation,have been reported to be frequent.These events are primarily caused by electrocautery-induced damage.Thus,ER techniques with a better safety profile are needed to overcome these shortcomings.Cold snare polypectomy,which has already been shown as a safer,equally effective pro-cedure compared to HSP for treatment of small colorectal polyps,is being increasingly evaluated as a potential therapeutic option for non-ampullary duodenal adenomas.The aim of this review is to report and discuss the early outcomes of the first experiences with cold snaring for SNADETs.

Repeat full-thickness resection device use for recurrent duodenal adenoma: A case report

BACKGROUND Endoscopic full-thickness resection of adenomas or subepithelial tumors is a novel and promising endoscopic technique.There have been several recent studies of full-thickness resection device(FTRD)use in the colon,but data regarding its use and efficacy in the duodenum are still limited.CASE SUMMARY A 64-year-old female underwent resection of a recurrent adenoma of 7 mm in size in the duodenum after FTRD use for an adenoma eight months prior.The biopsies revealed a low-grade adenoma.The adenoma was removed using the gastroduodenal FTRD,and the pathology results revealed clear margins.Except for minor bleeding that was treated by argon plasma coagulation,no further complications occurred.CONCLUSION Repeat use of the FTRD appears to be a safe and efficacious approach for the treatment of recurrent duodenal lesions.Further prospective studies are needed to investigate the long-term safety and utility of repeat FTRD use after Endoscopic full-thickness resection.

Adult duodenal intussusception with horizontal adenoma: A rare case report

BACKGROUND Adult duodenal intussusception rarely occurs,and the majority of duodenal adenomas are located in the descending part of the duodenum.Therefore,adenomas in the horizontal part of the duodenum presenting as duodenal intussusception in adults are extremely rare.CASE SUMMARY A 36-year-old man complained of abdominal pain for 13 d.Blood analysis showed anemia.Magnetic resonance cholangiopancreatography and computed tomography revealed a tumor in the horizontal part of the duodenum as the main finding,leading to duodeno-duodenal intussusception.No obvious abnormalities were found on endoscopy or upper gastrointestinal radiography.He was diagnosed with duodenal intussusception secondary to duodenal adenoma.Laparotomy showed duodeno-duodenal intussusception and a tumor in the horizontal part of the duodenum near the ascending part.Postoperative pathology revealed tubular-villous adenoma with low-grade glandular intraepithelial neoplasia(local high-grade intraepithelial neoplasia).He was discharged without complications.CONCLUSION This case highlights that rational use of computed tomography,magnetic resonance cholangiopancreatography,endoscopy and upper gastrointestinal radiography for preoperative diagnosis and timely surgery is an effective strategy for the treatment of adult duodenal intussusception with duodenal masses.

Application of endoscopic submucosal dissection in duodenal space-occupying lesions

BACKGROUNDEndoscopic submucosal dissection (ESD) has been advocated by digestiveendoscopists because of its comparable therapeutic effect to surgery, reducedtrauma, faster recovery, and fewer complications. However, ESD for lesions of theduodenum is more challenging than those occurring at other levels of thegastrointestinal tract due to the thin intestinal wall of the duodenum, narrowintestinal space, rich peripheral blood flow, proximity to vital organs, and highrisks of critical adverse events including intraoperative and delayed bleeding andperforation. Because of the low prevalence of the disease and the high risks ofsevere adverse events, successful ESD for lesions of the duodenum has rarelybeen reported in recent years.AIM To investigate the efficacy and safety of ESD in the treatment of duodenal spaceoccupyinglesions.METHODS Clinical data of 24 cases of duodenal lesions treated by ESD at the DigestiveEndoscopy Center of the Affiliated Hospital of Qingdao University from January2016 to December 2019 were retrospectively analyzed.RESULTS All of the 24 cases from 23 patients underwent ESD treatment for duodenal spaceoccupyinglesions under general anesthesia, including 15 male and 8 femalepatients, with a mean age of 58.5 (32.0-74.0) years. There were 12 lesions (50%) inthe duodenal bulb, 9 (37.5%) in the descending part, and 3 (12.5%) in the ball descending junction. The mean diameter of the lesion was 12.75 (range, 11-22)mm. Thirteen lesions originated from the mucosa, of which 4 were low-gradeintraepithelial neoplasia, 3 were hyperplastic polyps, 2 were chronic mucositis, 2were adenomatous hyperplasia, 1 was high-grade intraepithelial neoplasia, and 1was tubular adenoma. Eleven lesions were in the submucosa, including 5neuroendocrine neoplasms, 2 cases of ectopic pancreas, 1 stromal tumor, 1leiomyoma, 1 submucosal duodenal adenoma, and 1 case of submucosal lymphfollicular hyperplasia. The intraoperative perforation rate was 20.8% (5/24),including 4 submucosal protuberant lesions and 1 depressed lesion. The meanlength of hospital stay was 5.7 (range, 3-10) d, and the average follow-up time was25.8 (range, 3.0–50.0) mo. No residual disease or recurrence was found in allpatients, and no complications, such as infection and stenosis, were found duringthe follow-up period.CONCLUSION ESD is safe and effective in the treatment of duodenal lesions;however, theendoscopists should pay more attention to the preoperative preparation,intraoperative skills, and postoperative treatment.