Bauder Markus, Schmidt Arthur, Caca Karel
Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany.
Department of Gastroenterology, Medical Center, University of Freiburg, Freiburg im Breisgau, Baden-Württemberg, Germany.
United European Gastroenterol J. 2018 Aug;6(7):1015-1021. doi: 10.1177/2050640618773517. Epub 2018 May 12.
Endoscopic resections in the duodenum harbor a significant risk of complications. The full-thickness resection device (FTRD) has shown favorable results concerning efficacy and safety in the resection of colorectal lesions. Data of its use in the duodenum are limited to a single, small case series ( = 4).
Data of all consecutive patients scheduled for endoscopic full-thickness resection (EFTR) of duodenal lesions by FTRD in our institution were collected and analyzed retrospectively. Primary endpoint was technical success.
Between March 2014 and June 2017 EFTR of a duodenal lesion was planned in a total of 20 patients. Overall technical success was 17/20 (85.0%). Indication for EFTR was: adenomas ( = 13, seven treatment naïve, six pretreated), subepithelial tumors ( = 5) and T1 adenocarcinoma ( = 1). The FTRD could be advanced to the lesion in 19/20 cases (95.0%). R0-resection rate was 12/19 (63.2%). During follow-up after 3 and 12 months there were two recurrent adenomas that were successfully re-resected by FTRD. Minor bleedings occurred at the first postinterventional day in 3/19 (15.8%). There were no major bleedings and perforations.
This study confirmed the feasibility of duodenal EFTR and indicates good efficacy and safety. Larger studies are needed to further investigate this novel technique.
十二指肠内镜切除术有显著的并发症风险。全层切除装置（FTRD）在结直肠病变切除的有效性和安全性方面已显示出良好结果。其在十二指肠使用的数据仅限于一个小的单病例系列（n = 4）。
回顾性收集并分析了在我们机构计划用FTRD进行十二指肠病变内镜全层切除（EFTR）的所有连续患者的数据。主要终点是技术成功。
2014年3月至2017年6月，共有20例患者计划进行十二指肠病变的EFTR。总体技术成功率为17/20（85.0%）。EFTR的适应证为：腺瘤（n = 13，7例初治，6例曾接受过治疗）、上皮下肿瘤（n = 5）和T1期腺癌（n = 1）。在19/20例（95.0%）病例中，FTRD能够推进至病变部位。R0切除率为12/19（63.2%）。在3个月和12个月的随访期间，有2例复发性腺瘤通过FTRD成功再次切除。3/19例（15.8%）在介入后的第一天出现轻微出血。无大出血和穿孔发生。
本研究证实了十二指肠EFTR的可行性，并表明其具有良好的有效性和安全性。需要更大规模的研究来进一步探究这项新技术。
