Matsuda Y, Sakamoto K, Kataoka N, Yamaguchi T, Tomita M, Makimoto S. Perforation associated with endoscopic submucosal dissection for duodenal neoplasm without a papillary portion. World J Gastrointest Surg 2017; 9(7): 161-166 [PMID: 28824748 DOI: 10.4240/wjgs.v9.i7.161]
Corresponding Author of This Article
Yasuhiro Matsuda, MD, Department of Surgery, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-chou, Kishiwada city, Osaka 596-8522, Japan. my-salsa@air.ocn.ne.jp
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
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/
Yasuhiro Matsuda, Kazuki Sakamoto, Naoki Kataoka, Tomoyuki Yamaguchi, Masafumi Tomita, Shinichiro Makimoto, Department of Surgery, Kishiwada Tokushukai Hospital, Kishiwada City, Osaka 596-8522, Japan
Author contributions: Matsuda Y designed the research and wrote the paper; Sakamoto K designed the research and provided treatment; Sakamoto K, Kataoka N, Yamaguchi T, Tomita M and Makimoto S provided treatment and analyzed the data.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Kishiwada Tokushukai Hospital for ethical issues.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment without additional invasion.
Conflict-of-interest statement: The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.
Data sharing statement: Dataset available from the corresponding author at my-salsa@air.ocn.ne.jp.
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: Yasuhiro Matsuda, MD, Department of Surgery, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-chou, Kishiwada city, Osaka 596-8522, Japan. my-salsa@air.ocn.ne.jp
Telephone: +81-72-4459915 Fax: +81-72-4459791
Received: December 27, 2016 Peer-review started: December 30, 2016 First decision: January 28, 2017 Revised: May 26, 2017 Accepted: June 6, 2017 Article in press: June 8, 2017 Published online: July 27, 2017 Processing time: 208 Days and 22 Hours
Abstract
AIM
To investigate predictors of perforation after endoscopic resection (ER) for duodenal neoplasms without a papillary portion.
METHODS
This was a single-center, retrospective, cohort study conducted between April 2003 and September 2014. A total of 54 patients (59 lesions) underwent endoscopic mucosal resection (EMR) (n = 36) and endoscopic submucosal dissection (ESD) (n = 23). Clinical features, outcomes, and predictors of perforation were investigated.
RESULTS
Cases of perforation occurred in eight (13%) patients (95%CI: 4.7%-22.6%). Three ESD cases required surgical management because they could not be repaired by clipping. Delayed perforation occurred in two ESD cases, which required surgical management, although both patients underwent prophylactic clipping. All patients with perforation who required surgery had no postoperative complications and were discharged at an average of 13.2 d after ER. Perforation after ER showed a significant association with a tumor size greater than 20 mm (P = 0.014) and ESD (P = 0.047).
CONCLUSION
ESD for duodenal neoplasms exceeding 20 mm may be associated with perforation. ESD alone is not recommended for tumor treatment, and LECS should be considered as an alternative.
Core tip: Duodenal neoplasms are relatively rare, and endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) of the duodenum poses a high risk of complications. In our study, 54 patients (59 lesions) underwent EMR (n = 36) and ESD (n = 23). Cases of perforation occurred in eight (13%) patients (95%CI: 4.7%-22.6%), and perforation showed a significant association with a tumor size greater than 20 mm (P = 0.014) and ESD (P = 0.047). ESD for duodenal neoplasms exceeding 20 mm may be associated with perforation. ESD alone is not recommended as a treatment for tumor treatment, and laparoscopic and endoscopic cooperative surgery should be considered as an alternative.
