Endoscopic mucosal resection vs endoscopic submucosal dissection for superficial non-ampullary duodenal tumors

BACKGROUND The selection of endoscopic treatments for superficial non-ampullary duodenal epithelial tumors(SNADETs)is controversial.AIM To compare the efficacy and safety of endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)for SNADETs.METHODS We retrospectively analyzed the data of patients with SNADETs from a database of endoscopic treatment for SNADETs,which included eight hospitals in Fukuoka,Japan,between April 2001 and October 2017.A total of 142 patients with SNADETs treated with EMR or ESD were analyzed.Propensity score matching was performed to adjust for the differences in the patient characteristics between the two groups.We analyzed the treatment outcomes,including the rates of en bloc/complete resection,procedure time,adverse event rate,hospital stay,and local or metastatic recurrence.RESULTS Twenty-eight pairs of patients were created.The characteristics of patients between the two groups were similar after matching.The EMR group had a significantly shorter procedure time and hospital stay than those of the ESD group[median procedure time(interquartile range):6(3-10.75)min vs 87.5(68.5-136.5)min,P<0.001,hospital stay:8(6-10.75)d vs 11(8.25-14.75)d,P=0.006].Other outcomes were not significantly different between the two groups(en bloc resection rate:82.1%vs 92.9%,P=0.42;complete resection rate:71.4%vs 89.3%,P=0.18;and adverse event rate:3.6%vs 17.9%,P=0.19,local recurrence rate:3.6%vs 0%,P=1;metastatic recurrence rate:0%in both).Only one patient in the ESD group underwent emergency surgery owing to intraoperative perforation.CONCLUSION EMR has significantly shorter procedure time and hospital stay than ESD,and provides acceptable curability and safety compared to ESD.Accordingly,EMR for SNADETs is associated with lower medical costs.

Effectiveness and safety of endoscopic resection for duodenal gastrointestinal stromal tumors:A single center analysis

BACKGROUND Endoscopic resection for duodenal gastrointestinal stromal tumors(GISTs)is still considered a great challenge with a high risk of complications,including perforation,bleeding,tumor rupture,and residual tumor.AIM To assess the effectiveness and safety of endoscopic resection for duodenal GISTs.METHODS Between January 2010 and January 2022,11 patients with duodenal GISTs were treated with endoscopic resection.Data were extracted for the incidence of complete resection,bleeding,perforation,postoperative infection,recurrence,and distant metastasis.RESULTS The incidence of successful complete resection of duodenal GISTs was 100%.Three cases(27.3%)had suspected positive margins,and the other 8 cases(72.7%)had negative vertical and horizontal margins.Perforation occurred in all 11 patients.The success rate of perforation closure was 100%,while 1 patient(9.1%)had suspected delayed perforation.All bleeding during the procedure was managed by endoscopic methods.One case(9.1%)had delayed bleeding.Postoperative infection occurred in 6 patients(54.5%),including 1 who developed septic shock and 1 who developed a right iliac fossa abscess.All 11 patients recovered and were discharged.The mean hospital stay was 15.3 d.During the follow-up period(14-80 mo),duodenal stenosis occurred in 1 case(9.1%),and no local recurrence or distant metastasis were detected.CONCLUSION Endoscopic resection for duodenal GISTs appears to be an effective and safe minimally invasive treatment when performed by an experienced endoscopist.

Clinical outcomes of endoscopic resection of superficial nonampullary duodenal epithelial tumors: A 10-year retrospective, single-center study

BACKGROUND Although premalignant duodenal lesions such as adenomas are uncommon,the incidences of these lesions have increased in recent times,and thus,the demand for minimally invasive treatments such as endoscopic resection(ER)has also increased.However,ER in the duodenum is more challenging than ER in other locations of the gastrointestinal tract.AIM To evaluate the safety and efficacy of ER for superficial nonampullary duodenal epithelial tumors(SNADETs)METHODS We performed a retrospective observational study on 56 consecutive patients(58 lesions)diagnosed with SNADETs that underwent ER from January 2011 to December 2020 at Yeungnam University Hospital.Patient demographics,lesion characteristics,and procedural and technical data were collected,and clinical outcomes,including procedure-related complications,completeness of resection,and recurrence were analyzed.RESULTS Median patient age was 57 years[range,26–77,30(53.6%)men].Endoscopic mucosal resection(EMR)was performed on 57 lesions(98.3%)and snare polypectomy on one(1.7%).Lesions consisted of 52 adenomas with low-grade dysplasia(89.7%),3 adenomas with high-grade dysplasia(5.2%),and 3 intramucosal adenocarcinomas(5.2%).There were 16 cases of intraprocedural bleeding(27.6%)and 1 case of delayed bleeding(1.7%),and all these 17 cases were successfully managed endoscopically.No perforation or procedure-related death occurred.Larger lesion size was associated with an increased risk of EMR-related bleeding(P=0.033).During a median follow-up period of 23 mo(range 6–100 mo),no local recurrence occurred,despite the fact one-third of the patients(19 lesions,32.8%)underwent piecemeal resection and 3 patients(3 lesions,5.2%)that underwent en bloc resection had a pathologically determined positive lateral margin.No patient died from a primary duodenal neoplasm.CONCLUSION The majority of SNADETs can be safely and curatively resected by EMR,and thus,based on consideration of the high incidence of fatal complications attributable to ESD,we conclude EMR,including piecemeal resection,should be considered the treatment of first choice for SNADETs.

Exposed endoscopic full-thickness resection for duodenal submucosal tumors: Current status and future perspectives

Exposed endoscopic full-thickness resection(EFTR),with or without laparoscopic assistance,is an emergent natural orifice transluminal endoscopic surgery technique with promising safety and efficacy for the management of gastrointestinal submucosal tumors(SMTs)arising from the muscularis propria(MP),especially of the gastric wall.To date,evidence concerning duodenal exposed EFTR is lacking,mainly due to both the technical difficulty involved because of the special duodenal anatomy and concerns about safety and effectiveness of transmural wall defect closure.However,given the non-negligible morbidity and mortality associated with duodenal surgery,the recent availability of dedicated endoscopic tools for tissue-approximation capable to realize full-thickness defect closure could help in promoting the adoption of this endosurgical technique among referral centers.The aim of our study was to review the current evidence concerning exposed EFTR with or without laparoscopic assistance for the treatment of MP-arising duodenal SMTs.

Endoscopic diagnosis and treatment of superficial nonampullary duodenal tumors

The diagnostic and treatment guidelines of superficial non-ampullary duodenal tumors have not been standardized due to their low prevalence.Previous reports suggested that a superficial adenocarcinoma(SAC) should be treated via local resection because of its low risk of lymph node metastasis,whereas a highgrade adenoma(HGA) should be resected because of its high risk of progression to adenocarcinoma.Therefore,pretreatment diagnosis of SAC or HGA is important to determine the appropriate treatment strategy.There are certain endoscopic features known to be associated with SAC or HGA,and current practice prioritizes the endoscopic and biopsy diagnosis of these conditions.Surgical treatment of these duodenal lesions is often related to high risk of morbidity,and therefore endoscopic resection has become increasingly common in recent years.Endoscopic mucosal resection(EMR) and endoscopic submucosal dissection(ESD) are the commonly performed endoscopic resection methods.EMR is preferred due to its lower risk of adverse events;however,it has a higher risk of recurrence than ESD.Recently,a new and safer endoscopic procedure that reduces adverse events from EMR or ESD has been reported.

Selection of appropriate endoscopic therapies for duodenal tumors: An open-label study, single-center experience

AIM:To determine an appropriate compartmentalization of endoscopic submucosal dissection(ESD)or endoscopic mucosal resection(EMR)for duodenal tumors.METHODS:Forty-six duodenal lesions(excluding papillary lesions)from 44 patients with duodenal tumors treated endoscopically between 2005 and 2013 were divided into the ESD and EMR groups for retrospective comparison and analysis.RESULTS:The mean age was 65±9 years(35-79years).There were 24 lesions from men and 22 from women.The lesions consisted of 6 early cancers,31adenomas and 9 neuroendocrine tumors.Lesion location was the duodenal bulb in 15 cases and the descending part of the duodenum in 31 cases.The most common macroscopic morphology was elevated type in 21 cases(45.6%).Mean tumor diameter was 11.9±9.7 mm(3-60 mm).Treatment procedure was ESD(15 cases)vs EMR(31 cases).The examined parameters in the ESD vs EMR groups were as follows:mean tumor diameter,12.9±14.3 mm(3-60 mm)vs 11.4 ±6.7 mm(4-25 mm);en bloc resection rate,86.7%vs 83.9%;complete resection rate,86.7%vs 74.2%;procedure time,86.5±63.1 min(15-217 min)vs 13.2±17.0 min(2-89 min)(P<0.0001);intraprocedural perforation,3 cases vs none(P=0.0300);delayed perforation,none in either group;postprocedural bleeding,1 case vs none;mean postoperative length of hospitalization,8.2±2.9 d(5-16 d)vs 6.1±2.0 d(2-12 d)(P=0.0067);recurrence,none vs 1 case(occurring at 7 mo postoperatively).CONCLUSION:ESD was associated with a longer procedure time and a higher incidence of intraprocedural perforation;EMR was associated with a lower rate of complete resection.

Duodenal neuroendocrine tumor-tertiary care centre experience:A case report

BACKGROUND Neuroendocrine neoplasms(NENs)are a heterogeneous group of neoplasms arising from neuroendocrine cells,which contribute a small fraction of gastrointestinal malignancies.Duodenal neuroendocrine tumors(dNETs)represent 2%of all gastroenteropancreatic NENs.NENs are heterogeneous in terms of clinical symptoms,location,and prognosis.Non-functional NETs are mostly asymptomatic and need a high degree of clinical suspicion.Diagnosis of NETs is by endoscopic,endosonographic biopsy,and histopathological examination with immunohistochemistry staining for synaptophysin and chromogranin A.CASE SUMMARY We present case reports of 5 patients obtained over a period of 10 years in our center with dNETs.One patient had moderately differentiated NET and the remaining four had well-differentiated NET.Surveillance endoscopy was recommended in all the patients and is kept under regular follow-up after performing endoscopic therapy using endoscopic mucosal resection in 4 of them and one patient was advised to undergo a Whipple procedure.CONCLUSION Recently,the number of reported cases of NETs has increased due to advancements in diagnostic modalities and prevalence because of longer survival duration.The management differs based on the site,size,proliferation grade,and locally invasive pattern.They are slow-growing tumors with a good overall prognosis.The prognosis correlates with local lymph node status and metastasis.

Future directions of duodenal endoscopic submucosal dissection

Endoscopic therapies for lesions of the duodenum are technically more difficult than those for lesions of the other parts of the gastrointestinal tract due to the anatomical features of the duodenum, and the incidence rate of complications such as perforation and bleeding is also higher. These aforementioned trends were especially noticeable for the case of duodenal endoscopic submucosal dissection(ESD). The indication for ESD of duodenal tumors should be determined by assessment of the histopathology, macroscopic morphology, and diameter of the tumors. The three types of candidate lesions for endoscopic therapy are adenoma, carcinoma, and neuroendocrine tumors. For applying endoscopic therapies to duodenal lesions, accurate preoperative histopathological diagnosis is necessary. The most important technical issue in duodenal ESD is the submucosal dissection process. In duodenal ESD, a short needle-type knife is suitable for the mucosal incision and submucosal dissection processes, and the Small-caliber-tip Transparent hood is an important tool. After endoscopic therapies, the wound should be closed by clipping in order to prevent complications such as secondary hemorrhage and delayed perforation. At present, the criteria for selection between ESD and EMR vary among institutions. The indications for ESD should be carefully considered. Duodenal ESD should have limitations, such as the need for its being performed by experts with abundant experience in performing the procedure.

Clinicopathological evaluation of duodenal well-differentiated endocrine tumors

AIM:To assess the clinicopathological characteristics of duodenal well-differentiated endocrine tumors.METHODS:We examined clinicopathological characteristics in 11 consecutive patients with duodenal well-differentiated endocrine tumors treated by endoscopic therapy or surgery in our hospital from 1992 through 2007.Patients with well-differentiated endocrine tu-mors of the papilla of Vater or with gastrinoma were excluded.RESULTS:Three patients received endoscopic treatment,and 8 underwent surgery.In patients who received endoscopic treatment,the tumor diameter was less than 1.0 cm,with no histopathological evidence of lymphovascular invasion or invasion of the muscularis.There were no complications such as late bleedingor perforation after treatment.Among 8 patients with tumors less than 1.0 cm in diameter,3 underwent partial resection,and 2 underwent radical surgery.Three patients had lymphovascular invasion,1 had invasion of the muscularis,and 1 had proximal lymph node metastasis.Among 3 patients with tumors 1.0 cm or more in diameter,1 underwent partial resection,and 2 under-went radical surgery.One patient had lymphovascular invasion,with no lymph node metastasis.After treatment,all patients are alive and have remained free of metastasis and recurrence.CONCLUSION:Duodenal well-differentiated endocrine tumors less than 1.0 cm in diameter have a risk of lym-phovascular invasion,invasion of the muscularis,and lymph node metastasis,irrespective of procedural prob-lems.

Hybrid laparo-endoscopic access:New approach to surgical treatment for giant fibrovascular polyp of esophagus:A case report and review of literature

BACKGROUND Fibrovascular polyps are rare type of esophageal submucosal neoplasms.They are highly vascularized and can cause difficulty swallowing and even fatal complications such as uncontrolled bleeding and death caused by asphyxiation in case of tumor migration to oropharynx.In the article we describe a novel hybrid technique to surgical treatment–an endoscopic submucosal dissection with laparoscopic removal of the tumor.CASE SUMMARY The patient with a giant fibrovascular esophageal polyp presented with cough,discomfort in the throat,difficulty swallowing,and an episode of tumor migration into oropharynx.The patient was investigated with several imaging studies and was diagnosed with a giant highly vascularized esophageal fibrovascular polyp.The follow-up period of eight months accompanied with no complications.CONCLUSION This method has been shown to have comparable rates of recurrence and a low risk of complications.

1例十二指肠Brunner腺瘤内镜下黏膜切除术治疗实践

目的为十二指肠Brunner腺瘤的临床合理治疗提供参考。方法对1例十二指肠Brunner腺瘤进行诊疗,给予内科常规护理,完善各项化验检查;并根据患者的病情及其要求,于2021年10月31日行内镜下黏膜切除术(尼龙圈结扎、圈套器辅助、高频电切除)。结果疗效较好,无明显出血或穿孔,手术风险和治疗成本均较低;术后3个月复查发现,胃镜能顺利穿过幽门管、十二指肠腔,且患者无任何腹胀、呕吐等不良反应,体质量增加了8 kg。结论十二指肠Brunner腺瘤内镜下黏膜切除术创伤小,并发症少,安全有效。

腔镜下微创手术治疗甲状腺良性肿瘤的综合护理应用效果

目的:探究综合护理应用于腔镜下微创手术治疗甲状腺良性肿瘤患者中的效果.方法:选取2023年1—7月广西贺州市人民医院收治的甲状腺良性肿瘤微创手术治疗患者200例为研究对象,随机分为观察组及对照组,各100例.对照组采用传统护理,观察组采用综合护理.比较两组临床相关指标及护理满意度.结果:观察组住院时间、引流管留置时间短于对照组,住院费用、视觉模拟评分法评分低于对照组,差异有统计学意义(P<0.001);观察组护理满意度高于对照组,差异有统计学意义(P=0.024).结论:在腔镜下微创手术治疗甲状腺良性患者临床护理中应用综合护理的效果显著,有利于缓解患者疼痛程度,促进患者更快康复,且住院费用较低,患者满意度较高.

腔镜下耳后发际线径路面神经顺行解剖后腮腺良性肿瘤切除术的临床分析

目的探讨腔镜辅助下耳后发际线径路面神经顺行解剖后腮腺肿瘤切除手术的临床效果。方法选择2022年7月—2022年9月诊治的3例腮腺肿瘤位于浅叶并且直径小于3cm患者,采用发际线径路,在全腔镜下顺行解剖面神经后,行腮腺肿瘤和部分浅叶切除治疗。结果3例患者均顺利完成手术,均无术后出血、涎瘘及面瘫,收到良好的美容效果。结论腔镜下耳后发际线径路面神经顺行解剖后腮腺良性肿物切除术是一种安全可行、有良好美容效果的手术方式。

非壶腹部十二指肠浅表肿瘤内镜微创治疗的进展

近年来,随着内镜技术的不断发展,非壶腹部十二指肠浅表肿瘤(SNADET)病变的发现率逐渐增高,早期发现的SNADET较少进行远处转移,因此,诊断和治疗早期SNADET十分重要。该文通过对中外文献的查阅,分析汇总了SNADET内镜切除技术,以期为如何改善SNADET的内镜微创治疗,提高其疗效及安全性,提高患者的生活质量,对进一步深入研究提供思路与帮助。

经乳晕入路完全腔镜手术治疗良性甲状腺病变的临床价值研究

目的探讨经乳晕入路完全腔镜手术治疗良性病变的临床价值。方法选取2018年2月至2020年10月营口市第六人民医院收治的110例良性甲状腺病变患者作为研究对象,采用随机数字表法分为两组,每组55例。对照组采用颈部切口肿瘤切除术治疗,观察组采用经乳晕入路完全腔镜下甲状腺切除术治疗。比较两组手术时间、手术出血量、术后引流量、住院时间、并发症发生情况。结果观察组手术时间、住院时间均短于对照组,手术出血量、术后引流量均少于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率为1.82%,显著低于对照组的14.55%,差异有统计学意义(P<0.05)。结论经乳晕入路完全腔镜下甲状腺切除术治疗良性甲状腺病变,不仅可缩短患者手术时间、住院时间,减少手术出血量与术后引流量,且安全性较高,值得临床推广应用。

十二指肠乳头良性肿瘤内镜下切除术的护理

目的探讨十二指肠乳头良性肿瘤内镜下切除术及护理。方法共6例病人经病理证实良性病变,经过ERCP及超声内镜排除肿瘤腔内生长及转移,行内镜下乳头切除术,并做好术前、术中和术后护理工作。结果 6例患者均成功切除,未见并发症,随访3～24个月仅1例复发。结论十二指肠乳头良性肿瘤内镜下切除术是一种安全有效的治疗方法,要求术者有较高的内镜操作水平,良好的术中医护配合及严密的病情观察和护理是手术成功的关键。

经腋窝入路腔镜下甲状腺肿瘤切除术的护理

腔镜微创外科技术的发展及患者对美的追求,促进了腔镜手术不再局限于腹腔等原有的空腔内进行,并向潜在的腔隙或无腔隙区域发展,如腔镜下甲状腺手术,可以用微小切口,远离病变的切口在并不宽敞的空间完成手术操作^[1]。经腋窝入路腔镜下甲状腺肿瘤切除术具有极佳的美容效果，

改良Miccoli腔镜辅助下手术和经乳晕入路单孔法内镜下治疗甲状腺良性肿瘤效果观察

目的探讨改良Miccoli腔镜辅助下手术和经乳晕入路单孔法内镜下治疗甲状腺良性肿瘤的效果。方法对2015年8月~2017年3月我院60例甲状腺良性肿瘤患者进行筛选,依据患者意愿及要求选择手术治疗方式,对改良Miccoli组(30例)与经乳晕单孔组(30例)围术期机体创伤指标、手术指标、术后切口美容效果、术后疼痛指标等展开对比。结果两组创伤相关指标在术前均无差异(P>0.05),术后WBC、TSH测验水平均上升,血钙、PTH测验水平下降,且改良Miccoli组波动幅度相较经乳晕单孔组更为轻微,差异有统计学意义(P<0.05)。改良Miccoli组手术切口大小、术中出血量、术后引流总量、手术时间、住院时间指标统计均较经乳晕单孔组显著下降(P<0.05),住院费用远高于经乳晕单孔组(P<0.05)。改良Miccoli组患者颈部活动恢复时间相较经乳晕单孔组明显缩短,术后6 h、12 h及24 h疼痛值低于经乳晕单孔组(P<0.05)。对术后1周、1个月及1年切口的美容效果比较,改良Miccoli组均较经乳晕单孔组评分高(P<0.05)。改良Miccoli组并发症总发生率(10%)低于经乳晕单孔组(20%),差异有统计学意义(P<0.05);总满意度(93.33%)高于经乳晕单孔组(86.67%),但差异无统计学意义(P>0.05)。结论对甲状腺良性肿瘤患者予以改良Miccoli腔镜辅助手术及经乳晕入路单孔法内镜治疗,均可取得满意效果,但相对而言,前者对患者机体所造成的创伤应激更小,但费用更高,且后者手术切口位于隐秘部位,颈部无创,故临床在选择术式可充分考虑患者意愿,取更适宜术式。

16例食管固有肌层平滑肌瘤患者行内镜经黏膜下隧道切除术的护理

目的探讨内镜经黏膜下隧道切除术(submucosal tunelling endoscopic resection,STER)治疗食管固有肌层平滑肌瘤的护理要点。方法回顾性分析总结16例食管固有肌层平滑肌瘤患者采用STER的护理经验。结果 16例患者均顺利实施STER手术,一次性切除率100.0%,无严重并发症发生。结论术前做好心理护理,术中密切配合,术后加强护理对保证STER手术的顺利进行具有积极的意义。

内镜下全层切除术治疗消化道黏膜下层肿瘤的护理

目的总结内镜下全层切除术治疗消化道黏膜下层肿瘤患者的护理。方法通过对26例行内镜下全层切除术治疗消化道黏膜下层肿瘤患者的护理,总结术前护理、术中配合、术后观察及宣教的要点。结果所有患者均于5-10d出院,2个月后复查胃镜,均提示创面愈合良好。结论内镜技术的发展对护理工作的要求日益提高,恰当的术前宣教、精确的术中配合、严密的病情观察,能有效保障内镜下全层切除术顺利完成。