Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Korean J Gastroenterol. 2021 Apr 25;77(4):164-170. doi: 10.4166/kjg.2021.039.
Superficial nonampullary duodenal epithelial tumors are considered rare but have been increasingly recognized in recent years. Accordingly, the importance of endoscopic treatment for the lesions are also increasing. An endoscopic resection can be considered for duodenal adenoma and mucosal cancer. The choice of resection method should be made based on the size of the lesion, endoscopic findings, pathologic diagnosis, and risk of procedure-related complication. For small adenomas <10 mm in size, endoscopic mucosal resection (EMR), cold snare polypectomy, and underwater EMR can be considered. An or piecemeal resection using EMR or underwater EMR can be selected for 10-20 mm sized adenomas. For lesions ≥20 mm in size or suspicious for mucosal cancer, an endoscopic submucosal dissection followed by closure of the mucosal defect conducted by an experienced endoscopist is appropriate.
表浅型非壶腹十二指肠上皮肿瘤虽较为罕见，但近年来其检出率逐渐增高。因此，内镜治疗在这类疾病中的重要性也日益凸显。内镜下切除可适用于十二指肠腺瘤和黏膜癌。对于病变，应根据病变大小、内镜表现、病理诊断和与操作相关并发症风险来选择切除方式。对于直径＜10mm 的小腺瘤，可以考虑内镜下黏膜切除术（EMR）、冷圈套息肉切除术和水下 EMR。对于 10-20mm 大小的腺瘤，可以选择 EMR 或水下 EMR 的整块或分片切除。对于直径≥20mm 的病变或疑似黏膜癌，应由经验丰富的内镜医生行内镜黏膜下剥离术，然后对黏膜缺损进行封闭。
