Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2017; 9(7): 161-166
Published online Jul 27, 2017. doi: 10.4240/wjgs.v9.i7.161
Perforation associated with endoscopic submucosal dissection for duodenal neoplasm without a papillary portion
Yasuhiro Matsuda, Kazuki Sakamoto, Naoki Kataoka, Tomoyuki Yamaguchi, Masafumi Tomita, Shinichiro Makimoto
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
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:
Correspondence to: Yasuhiro Matsuda, MD, Department of Surgery, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-chou, Kishiwada city, Osaka 596-8522, Japan.
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
Core Tip

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.