Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Endoscopy. 2013;45(2):133-5. doi: 10.1055/s-0032-1326178. Epub 2013 Jan 30.
Although endoscopic submucosal dissection (ESD) is increasingly utilized to treat early neoplasms of the gastrointestinal tract, its use for duodenal neoplasms is limited by the thin wall and narrow lumen of the duodenum. We have reviewed cases where ESD was used to treat sessile, nonampullary duodenal neoplasms. To do this, we retrospectively reviewed the medical records of patients treated with ESD for adenomas of the duodenum from January 2001 to December 2010, assessing the curative outcomes and complication rates. A total of 14 cases were reviewed. Mean patient age was 56.4 years. The mean size of tumors and mean size of the specimens were 17.1 mm and 26.4 mm, respectively. The en bloc resection rate with ESD was 78.6%, and the complete (R0) resection rate was 85.7%. No patient in the study experienced major bleeding. However, second-look endoscopy revealed minor bleeding requiring endoscopic homeostasis in one case (7.1%). Perforations were observed in five cases (35.7%). Two of the five patients with perforation underwent surgery. The ESD methods yielded acceptable curative resection rates for duodenal adenomas, although ESD was associated with a higher rate of perforation. Therefore, duodenal ESD should be performed with care and only in selected patients to avoid serious complications.
虽然内镜黏膜下剥离术（ESD）越来越多地用于治疗胃肠道的早期肿瘤，但由于十二指肠壁薄且管腔狭窄，其在十二指肠肿瘤中的应用受到限制。我们回顾了使用 ESD 治疗十二指肠固有非壶腹型平坦型肿瘤的病例。为此，我们回顾性分析了 2001 年 1 月至 2010 年 12 月期间接受 ESD 治疗的十二指肠腺瘤患者的病历，评估了治疗效果和并发症发生率。共回顾了 14 例病例。患者平均年龄为 56.4 岁。肿瘤的平均大小和标本的平均大小分别为 17.1mm 和 26.4mm。ESD 的整块切除率为 78.6%，完全（R0）切除率为 85.7%。研究中无患者发生大出血。然而，1 例（7.1%）患者在第二内镜检查时出现需要内镜下止血的轻微出血。5 例（35.7%）患者发生穿孔。5 例穿孔患者中，有 2 例接受了手术治疗。尽管 ESD 相关的穿孔发生率较高，但 ESD 方法对十二指肠腺瘤具有可接受的治疗性切除率。因此，应谨慎进行十二指肠 ESD，并仅在选定的患者中进行，以避免严重并发症。
