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01-06-2018

Endoscopic and surgical management of nonampullary duodenal neoplasms

Authors: Michael J. Bartel, Ruchir Puri, Bhaumik Brahmbhatt, Wei-Chung Chen, Daniel Kim, Carlos Roberto Simons-Linares, John A. Stauffer, Mauricia A. Buchanan, Steven P. Bowers, Timothy A. Woodward, Michael B. Wallace, Massimo Raimondo, Horacio J. Asbun

Published in: Surgical Endoscopy | Issue 6/2018

Abstract

Background

Sporadic nonampullary duodenal neoplasms (SNADN) can have malignant potential for which endoscopic and surgical resections are offered. We report combined gastroenterologic and surgical experience for treatment of SNADN, including endoscopic mucosal resection (EMR) and pancreas-preserving partial duodenectomy (PPPD).

Methods

We retrospectively reviewed 121 consecutive patients, who underwent 30 PPPDs and 91 EMRs for mucosal and submucosal SNADN. Decision to undergo EMR or surgical resection was based on expert endoscopist and surgeon discretion including multidisciplinary tumor board review. Main outcomes were recurrence rate of neoplasia and adverse events requiring hospital admission or prolonged care. EMRs were performed with submucosal lifting followed by snare resection. PPPD included total duodenectomy, supra-ampullary PPPD for neoplasms proximal to the ampulla, and infra-ampullary PPPD for lesions distal to the ampulla. Follow-up data were available for 65% of EMR and 73% of surgical patients.

Results

Surgically resected neoplasia was larger with more advanced neoplasia and submucosal lesions. En bloc resection was achieved in all surgical resections and in 53% of EMRs. Post-EMR, mucosal and submucosal neoplasia recurred in 32 and 0%, respectively, including five neoplasms (26%) after an initial negative esophagogastroduodenoscopy. All recurrences were treated endoscopically. Complications occurred in 14 endoscopically and eight surgically treated patients, none requiring surgical intervention.

Conclusions

Post-EMR patients had higher recurrence of mucosal neoplasia, whereas submucosal neoplasms, mainly carcinoid, did not recur. Polyp size and positive resection margin were not associated with neoplasia recurrence. Patients with SNADN could benefit from a multidisciplinary approach to stratify the optimal treatment based on local expertise.

Jepsen JM, Persson M, Jakobsen NO, Christiansen T, Skoubo-Kristensen E, Funch-Jensen P, Kruse A, Thommesen P (1994) Prospective study of prevalence and endoscopic and histopathologic characteristics of duodenal polyps in patients submitted to upper endoscopy. Scand J Gastroenterol 29:483–487CrossRefPubMed

Hochter W, Weingart J, Seib HJ, Ottenjann R (1984) Duodenal polyps. Incidence, histologic substrate and significance. Deutsche medizinische Wochenschrift 109:1183–1186CrossRefPubMed

Jung SH, Chung WC, Kim EJ, Kim SH, Paik CN, Lee BI, Cho YS, Lee KM (2010) Evaluation of non-ampullary duodenal polyps: comparison of non-neoplastic and neoplastic lesions. World J Gastroenterol 16:5474–5480CrossRefPubMedPubMedCentral

Okada K, Fujisaki J, Kasuga A, Omae M, Kubota M, Hirasawa T, Ishiyama A, Inamori M, Chino A, Yamamoto Y, Tsuchida T, Nakajima A, Hoshino E, Igarashi M (2011) Sporadic nonampullary duodenal adenoma in the natural history of duodenal cancer: a study of follow-up surveillance. Am J Gastroenterol 106:357–364CrossRefPubMed

Oka S, Tanaka S, Nagata S, Hiyama T, Ito M, Kitadai Y, Yoshihara M, Haruma K, Chayama K (2003) Clinicopathologic features and endoscopic resection of early primary nonampullary duodenal carcinoma. J Clin Gastroenterol 37:381–386CrossRefPubMed

Kim GH, Kim JI, Jeon SW, Moon JS, Chung IK, Jee SR, Kim HU, Seo GS, Baik GH, Lee YC, Upper Gastrointestinal R Korean College of H. (2014) Endoscopic resection for duodenal carcinoid tumors: a multicenter, retrospective study. J Gastroenterol Hepatol 29:318–324CrossRefPubMed

Honda T, Yamamoto H, Osawa H, Yoshizawa M, Nakano H, Sunada K, Hanatsuka K, Sugano K (2009) Endoscopic submucosal dissection for superficial duodenal neoplasms. Dig Endosc 21:270–274CrossRefPubMed

Hoteya S, Yahagi N, Iizuka T, Kikuchi D, Mitani T, Matsui A, Ogawa O, Yamashita S, Furuhata T, Yamada A, Kimura R, Nomura K, Kuribayashi Y, Kaise M (2013) Endoscopic submucosal dissection for nonampullary large superficial adenocarcinoma/adenoma of the duodenum: feasibility and long-term outcomes. Endosc Int Open 1:2–7CrossRefPubMedPubMedCentral

Endo M, Abiko Y, Oana S, Kudara N, Chiba T, Suzuki K, Koizuka H, Uesugi N, Sugai T (2010) Usefulness of endoscopic treatment for duodenal adenoma. Dig Endosc 22:360–365CrossRefPubMed

10.

Sohn JW, Jeon SW, Cho CM, Jung MK, Kim SK, Lee DS, Son HS, Chung IK (2010) Endoscopic resection of duodenal neoplasms: a single-center study. Surg Endosc 24:3195–3200CrossRefPubMed

11.

Lepilliez V, Chemaly M, Ponchon T, Napoleon B, Saurin JC (2008) Endoscopic resection of sporadic duodenal adenomas: an efficient technique with a substantial risk of delayed bleeding. Endoscopy 40:806–810CrossRefPubMed

12.

Kim HK, Chung WC, Lee BI, Cho YS (2010) Efficacy and long-term outcome of endoscopic treatment of sporadic nonampullary duodenal adenoma. Gut Liver 4:373–377CrossRefPubMedPubMedCentral

13.

Kedia P, Brensinger C, Ginsberg G (2010) Endoscopic predictors of successful endoluminal eradication in sporadic duodenal adenomas and its acute complications. Gastrointest Endosc 72:1297–1301CrossRefPubMed

14.

Alexander S, Bourke MJ, Williams SJ, Bailey A, Co J (2009) EMR of large, sessile, sporadic nonampullary duodenal adenomas: technical aspects and long-term outcome (with videos). Gastrointest Endosc 69:66–73CrossRefPubMed

15.

Yamamoto Y, Yoshizawa N, Tomida H, Fujisaki J, Igarashi M (2014) Therapeutic outcomes of endoscopic resection for superficial non-ampullary duodenal tumor. Dig Endosc 26(Suppl 2):50–56CrossRefPubMed

16.

Abbass R, Rigaux J, Al-Kawas FH (2010) Nonampullary duodenal polyps: characteristics and endoscopic management. Gastrointest Endosc 71:754–759CrossRefPubMed

17.

Basford PJ, George R, Nixon E, Chaudhuri T, Mead R, Bhandari P (2014) Endoscopic resection of sporadic duodenal adenomas: comparison of endoscopic mucosal resection (EMR) with hybrid endoscopic submucosal dissection (ESD) techniques and the risks of late delayed bleeding. Surg Endosc 28:1594–1600CrossRefPubMed

18.

Fanning SB, Bourke MJ, Williams SJ, Chung A, Kariyawasam VC (2012) Giant laterally spreading tumors of the duodenum: endoscopic resection outcomes, limitations, and caveats. Gastrointest Endosc 75:805–812CrossRefPubMed

19.

Min YW, Min BH, Kim ER, Lee JH, Rhee PL, Rhee JC, Kim JJ (2013) Efficacy and safety of endoscopic treatment for nonampullary sporadic duodenal adenomas. Dig Dis Sci 58:2926–2932CrossRefPubMed

20.

Navaneethan U, Lourdusamy D, Mehta D, Lourdusamy V, Venkatesh PG, Sanaka MR (2014) Endoscopic resection of large sporadic non-ampullary duodenal polyps: efficacy and long-term recurrence. Surg Endosc 28:2616–2622CrossRefPubMed

21.

Nonaka S, Oda I, Tada K, Mori G, Sato Y, Abe S, Suzuki H, Yoshinaga S, Nakajima T, Matsuda T, Taniguchi H, Saito Y, Maetani I (2015) Clinical outcome of endoscopic resection for nonampullary duodenal tumors. Endoscopy 47:129–135CrossRefPubMed

22.

Seo JY, Hong SJ, Han JP, Jang HY, Myung YS, Kim C, Lee YN, Ko BM (2014) Usefulness and safety of endoscopic treatment for nonampullary duodenal adenoma and adenocarcinoma. J Gastroenterol Hepatol 29:1692–1698CrossRefPubMed

23.

Standards of Practice C, Adler DG, Qureshi W, Davila R, Gan SI, Lichtenstein D, Rajan E, Shen B, Zuckerman MJ, Fanelli RD, Van Guilder T, Baron TH (2006) The role of endoscopy in ampullary and duodenal adenomas. Gastrointest Endosc 64:849–854CrossRef

24.

Gaspar JP, Stelow EB, Wang AY (2016) Approach to the endoscopic resection of duodenal lesions. World J Gastroenterol 22:600–617CrossRefPubMedPubMedCentral

25.

Poves I, Burdio F, Alonso S, Seoane A, Grande L (2011) Laparoscopic pancreas-sparing subtotal duodenectomy. JOP 12:62–65PubMed

26.

Klein A, Nayyar D, Bahin FF, Qi Z, Lee E, Williams SJ, Byth K, Bourke MJ (2016) Endoscopic mucosal resection of large and giant lateral spreading lesions of the duodenum: success, adverse events, and long-term outcomes. Gastrointest Endosc 84:688–696CrossRefPubMed

27.

Moss A, Williams SJ, Hourigan LF, Brown G, Tam W, Singh R, Zanati S, Burgess NG, Sonson R, Byth K, Bourke MJ (2015) Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian Colonic EMR (ACE) study. Gut 64:57–65CrossRefPubMed

28.

Yamamoto H, Miura Y (2014) Duodenal ESD: conquering difficulties. Gastrointest Endosc Clin N Am 24:235–244CrossRefPubMed

29.

Committee ASoP, Chathadi KV, Khashab MA, Acosta RD, Chandrasekhara V, Eloubeidi MA, Faulx AL, Fonkalsrud L, Lightdale JR, Salztman JR, Shaukat A, Wang A, Cash BD, DeWitt JM (2015) The role of endoscopy in ampullary and duodenal adenomas. Gastrointest Endosc 82:773–781CrossRef

30.

Vallance S (1990) Duodenectomy without pancreatectomy for extensive benign villous adenoma of the duodenum. Aust Nz J Surg 60:311–314CrossRef

31.

Marcello PW, Asbun HJ, Veidenheimer MC, Rossi RL, Roberts PL, Fine SN, Coller JA, Murray JJ, Schoetz DJ Jr (1996) Gastroduodenal polyps in familial adenomatous polyposis. Surg Endosc 10:418–421CrossRefPubMed

32.

Stauffer JA, Raimondo M, Woodward TA, Goldberg RF, Bowers SP, Asbun HJ (2013) Laparoscopic partial sleeve duodenectomy (PSD) for nonampullary duodenal neoplasms: avoiding a whipple by separating the duodenum from the pancreatic head. Pancreas 42:461–466CrossRefPubMed

Title: Endoscopic and surgical management of nonampullary duodenal neoplasms
Authors: Michael J. Bartel
Ruchir Puri
Bhaumik Brahmbhatt
Wei-Chung Chen
Daniel Kim
Carlos Roberto Simons-Linares
John A. Stauffer
Mauricia A. Buchanan
Steven P. Bowers
Timothy A. Woodward
Michael B. Wallace
Massimo Raimondo
Horacio J. Asbun
Publication date: 01-06-2018
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 6/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-017-5994-y

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Springer Medicine

Endoscopic and surgical management of nonampullary duodenal neoplasms

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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