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World J Gastroenterol. Sep 21, 2014; 20(35): 12501-12508
Published online Sep 21, 2014. doi: 10.3748/wjg.v20.i35.12501
Treatment for superficial non-ampullary duodenal epithelial tumors
Naomi Kakushima, Hideyuki Kanemoto, Masaki Tanaka, Kohei Takizawa, Hiroyuki Ono
Naomi Kakushima, Masaki Tanaka, Kohei Takizawa, Hiroyuki Ono, Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Suntougun, Shizuoka 4118777, Japan
Hideyuki Kanemoto, Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Suntougun, Shizuoka 4118777, Japan
Author contributions: Kakushima N, Kanemoto H, Tanaka M, Takizawa K and Ono H contributed to conception and design, acquisition of data, or analysis and interpretation of data; drafted the article or revised it critically for important intellectual content; and final approval of the version to be published.
Correspondence to: Naomi Kakushima, MD, PhD, Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Suntougun, Shizuoka 4118777, Japan. kakushin-tky@umin.ac.jp
Telephone: +81-55-9895222 Fax: +81-55-9895692
Received: January 20, 2014
Revised: April 18, 2014
Accepted: May 19, 2014
Published online: September 21, 2014
Processing time: 241 Days and 20.7 Hours
Abstract

Because of the low prevalence of non-ampullary duodenal epithelial tumors (NADETs), standardized clinical management of sporadic superficial NADETs, including diagnosis, treatment, and follow-up, has not yet been established. Retrospective studies have revealed certain endoscopic findings suggestive of malignancy. Duodenal adenoma with high-grade dysplasia and mucosal cancer are candidates for local resection by endoscopic or minimally invasive surgery. The use of endoscopic treatment including endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), for the treatment for superficial NADETs is increasing. EMR requires multiple sessions to achieve complete remission and repetitive endoscopy is needed after resection. ESD provides an excellent complete resection rate, however it remains a challenging method, considering the high risk of intraoperative or delayed perforation. Minimally invasive surgery such as wedge resection and pancreas-sparing duodenectomy are beneficial for superficial NADETs that are technically difficult to remove by endoscopic treatment. Pancreaticoduodenectomy remains a standard surgical procedure for treatment of duodenal cancer with submucosal invasion, which presents a risk of lymph node metastasis. Endoscopic or surgical treatment outcomes of superficial NADETs without submucosal invasion are satisfactory. Establishing an endoscopic diagnostic tool to differentiate superficial NADETs between adenoma and cancer as well as between mucosal and submucosal cancer is required to select the most appropriate treatment.

Keywords: Duodenal neoplasms; Duodenal cancer; Pancreaticoduodenectomy; Endoscopic surgery; Esophagogastroduodenoscopy

Core tip: Superficial non-ampullary duodenal epithelial tumors (NADETs) including adenoma and mucosal cancer are candidates for local resection regarding the nil risk of lymph node metastasis. Pancreaticoduodenectomy remains a standard surgical procedure for treatment of duodenal cancer with submucosal invasion. Preoperative diagnosis to differentiate superficial NADETs between adenoma and cancer as well as between mucosal and submucosal cancer is essential to select minimally invasive treatment such as endoscopic resection or minimally invasive surgery.