Shibagaki Kotaro, Ishimura Norihisa, Kinoshita Yoshikazu
Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan.
Ann Transl Med. 2017 Apr;5(8):188. doi: 10.21037/atm.2017.03.63.
Recently, endoscopic submucosal dissection (ESD) for the duodenal tumors has come to be treated in many institutions, but has also showed many problems of feasibility and safety compared with endoscopic mucosal resection (EMR). Although duodenal ESD is expected to be more effective for the prevention of postoperative local recurrence, high incidence rate of duodenal perforation and emergency surgical rescue are big problem. Prophylactic mucosal closure by clipping device, polyglycolic acid sheets shielding, and the laparoscopic and endoscopic cooperative surgery are reported to be effective measures to overwhelm the various problems associated with duodenal ESD. However, duodenal ESD still has quite a bit of room for improvement of the procedure, and currently the indication should be well discussed before treatment in consideration of the expected therapeutic effect and complications.
近年来，许多机构都开展了十二指肠肿瘤的内镜黏膜下剥离术（ESD），但与内镜黏膜切除术（EMR）相比，该手术也暴露出诸多可行性和安全性问题。尽管十二指肠ESD有望更有效地预防术后局部复发，但十二指肠穿孔的高发生率和急诊手术抢救仍是大问题。据报道，使用夹子装置进行预防性黏膜闭合、聚乙醇酸片覆盖以及腹腔镜与内镜联合手术是应对十二指肠ESD相关各种问题的有效措施。然而，十二指肠ESD在手术操作方面仍有很大的改进空间，目前在治疗前应充分讨论适应证，综合考虑预期治疗效果和并发症。
