Tsuji Shigetsugu, Doyama Hisashi, Tsuji Kunihiro, Tsuyama Sho, Tominaga Kei, Yoshida Naohiro, Takemura Kenichi, Yamada Shinya, Niwa Hideki, Katayanagi Kazuyoshi, Kurumaya Hiroshi, Okada Toshihide
Shigetsugu Tsuji, Hisashi Doyama, Kunihiro Tsuji, Kei Tominaga, Naohiro Yoshida, Kenichi Takemura, Shinya Yamada, Toshihide Okada, Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa 920-8530, Japan.
World J Gastroenterol. 2015 Nov 7;21(41):11832-41. doi: 10.3748/wjg.v21.i41.11832.
Superficial non-ampullary duodenal epithelial tumor (SNADET) is defined as a sporadic tumor that is confined to the mucosa or submucosa that does not arise from Vater's papilla, and it includes adenoma and adenocarcinoma. Recent developments in endoscopic technology, such as high-resolution endoscopy and image-enhanced endoscopy, may increase the chances of detecting SNADET lesions. However, because SNADET is rare, little is known about its preoperative endoscopic diagnosis. The use of endoscopic resection for SNADET, which has no risk of metastasis, is increasing, but the incidence of complications, such as perforation, is significantly higher than in any other part of the digestive tract. A preoperative diagnosis is required to distinguish between lesions that should be followed up and those that require treatment. Retrospective studies have revealed certain endoscopic findings that suggest malignancy. In recent years, several new imaging modalities have been developed and explored for real-time diagnosis of these lesion types. Establishing an endoscopic diagnostic tool to differentiate between adenoma and adenocarcinoma in SNADET lesions is required to select the most appropriate treatment. This review describes the current state of knowledge about preoperative endoscopic diagnosis of SNADETs, such as duodenal adenoma and duodenal adenocarcinoma. Newer endoscopic techniques, including magnifying endoscopy, may help to guide these diagnostics, but their additional advantages remain unclear, and further studies are required to clarify these issues.
浅表非壶腹十二指肠上皮肿瘤（SNADET）被定义为一种散发性肿瘤，局限于黏膜或黏膜下层，并非起源于 Vater 乳头，包括腺瘤和腺癌。内镜技术的最新进展，如高分辨率内镜和图像增强内镜，可能会增加检测 SNADET 病变的机会。然而，由于 SNADET 较为罕见，其术前内镜诊断知之甚少。对无转移风险的 SNADET 使用内镜切除术的情况正在增加，但诸如穿孔等并发症的发生率明显高于消化道的其他任何部位。需要进行术前诊断以区分应随访的病变和需要治疗的病变。回顾性研究揭示了某些提示恶性的内镜表现。近年来，已开发并探索了几种新的成像方式用于这些病变类型的实时诊断。需要建立一种内镜诊断工具来区分 SNADET 病变中的腺瘤和腺癌，以选择最合适的治疗方法。本综述描述了关于 SNADET（如十二指肠腺瘤和十二指肠腺癌）术前内镜诊断的当前知识状况。包括放大内镜在内的更新的内镜技术可能有助于指导这些诊断，但其额外优势尚不清楚，需要进一步研究来阐明这些问题。
