Endoscopy Center, Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
Surg Endosc. 2019 Nov;33(11):3605-3611. doi: 10.1007/s00464-018-06644-3. Epub 2019 Jun 25.
Standard treatment for nonampullary duodenal tumors has not yet been established. In case of tumors originated from the muscularis propria (MP) layer and adherent to the serosa layer, the lesions can not be completely removed by ESD. However, with the development of the endoscopic suture technique, endoscopic full-thickness resection (EFTR) of duodenal subepithelial lesions has become possible.
We retrospectively analyzed 32 patients with nonampullary duodenal subepithelial lesions who underwent EFTR between February 2012 and January 2017. The suturing method, complications that occurred during and after the operations, perioperative management, tumor characteristics, and pathological findings were analyzed in all patients.
The complete resection rate was 100%; all patients successfully received EFTR except for one patient who required conversion to open surgery. Severe abdominal pain was observed after the operation in one patient who then received laparoscopic exploration, and the possibility of delayed perforation was considered. Another patient showed a decline in blood oxygen saturation (SO) and was transferred to the intensive care unit (ICU) for further management. Delayed bleeding and fistula were not observed. All patients achieved complete remission.
EFTR is a safe, minimally invasive treatment modality that ensures complete eradication of the duodenal subepithelial lesions.
非壶腹十二指肠肿瘤的标准治疗方法尚未确立。对于起源于固有肌层（MP）并黏附于浆膜层的肿瘤，ESD 无法完全切除病灶。然而，随着内镜缝合技术的发展，十二指肠黏膜下病变的内镜全层切除术（EFTR）已成为可能。
我们回顾性分析了 2012 年 2 月至 2017 年 1 月期间接受 EFTR 的 32 例非壶腹十二指肠黏膜下病变患者。对所有患者的缝合方法、手术期间和手术后发生的并发症、围手术期管理、肿瘤特征和病理发现进行了分析。
完全切除率为 100%；除 1 例患者需要转为开放性手术外，所有患者均成功接受 EFTR。1 例患者术后出现严重腹痛，随后行腹腔镜探查，考虑延迟穿孔的可能性。另 1 例患者出现血氧饱和度（SO）下降，并转至重症监护病房（ICU）进一步治疗。未观察到延迟性出血和瘘管。所有患者均达到完全缓解。
EFTR 是一种安全、微创的治疗方法，可确保完全清除十二指肠黏膜下病变。
