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Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Sep 16, 2018; 10(9): 156-164
Published online Sep 16, 2018. doi: 10.4253/wjge.v10.i9.156
Endoscopic diagnosis and treatment of superficial non-ampullary duodenal tumors
Mitsuru Esaki, Sho Suzuki, Hisatomo Ikehara, Chika Kusano, Takuji Gotoda
Mitsuru Esaki, Sho Suzuki, Hisatomo Ikehara, Chika Kusano, Takuji Gotoda, Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo 1018309, Japan
Author contributions: All authors contributed equally to the conception and design of the current study, literature review and analysis, drafting and critical revision and editing, and approved the final version.
Conflict-of-interest statement: There are no potential conflicts of interest or financial support to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sho Suzuki, MD, PhD, Doctor, Research Associate, Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo 1018309, Japan. s.sho.salubriter.mail@gmail.com
Telephone: +81-3-32931711 Fax: +81-3-32931711
Received: March 23, 2018
Peer-review started: March 23, 2018
First decision: April 26, 2018
Revised: June 17, 2018
Accepted: June 28, 2018
Article in press: June 28, 2018
Published online: September 16, 2018
Abstract

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 high-grade 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.

Keywords: Endoscopic resection, Endoscopic mucosal resection, Superficial non-ampullary duodenal tumor, Endoscopic submucosal dissection, Closure

Core tip: Although superficial non-ampullary duodenal tumors are rare, they can progress to cancer and metastasize, and therefore early diagnosis and treatment of these duodenal tumors is essential. Pretreatment diagnosis for high-grade adenoma or superficial adenocarcinoma helps to determine the appropriate treatment strategy. Endoscopic resection has been adopted as an effective and minimally invasive treatment for these duodenal lesions; however, even though endoscopic mucosal resection has a lower risk of adverse events, it has a higher risk of recurrence than endoscopic submucosal dissection. Recently, a new and safer endoscopic procedure that reduces adverse events of endoscopic resection has been reported.