Inokuchi Yasuhiro, Hayashi Kei, Kaneta Yoshihiro, Okubo Yoichiro, Watanabe Mamoru, Furuta Mitsuhiro, Machida Nozomu, Maeda Shin
Chief Doctor, Department of Gastroenterology, Kanagawa Cancer Center, 2-3-2 Asahi-ku, Nakao, Yokohama 241-8515, Kanagawa, Japan.
Department of Gastroenterology, Kanagawa Cancer Center, Yokohama, Japan.
Ther Adv Gastrointest Endosc. 2022 Jun 9;15:26317745221103735. doi: 10.1177/26317745221103735. eCollection 2022 Jan-Dec.
Duodenal neuroendocrine tumors (DNETs) smaller than 1 cm in diameter, without invasion to the muscularis propria, have a low risk of metastasis. Therefore, DNETs are frequently resected endoscopically. However, among the various procedures, the best fit for DNET in terms of feasibility, effectiveness, and simplicity is unclear.
Patients with DNET who underwent endoscopic submucosal resection using a ligation device (ESMR-L) at Kanagawa Cancer Center between May 2003 and December 2020 were studied retrospectively to evaluate clinical characteristics and short-term and long-term outcomes.
Eleven consecutive patients with 12 lesions were treated with 12 sessions of ESMR-L. Lesions were discovered in patients at a median age of 68 (range, 50-83) years. One patient had two lesions at the time of the initial ESMR-L session. Eleven of the 12 lesions (91.7%) existed in the duodenal bulb, of which 10 (83.3%) were in the anterior wall, and the remaining one (8.3%) existed in the descending part of the duodenum. The and R0 resection rates were 100% and 75%, respectively. The rates of bleeding and perforation were both 0%. Among the four patients who had non-curative resections, two patients underwent additional surgery after ESMR-L. One patient had a local remnant tumor, and the other had lymph node metastasis. In cases of local remnant tumors, the vertical margin was positive in the ESMR-L specimen. In that case, ligation by the O-ring was insufficient, retrospectively. All patients had no recurrence during the median follow-up period of 5.7 years.
ESMR-L was the best fit for DNET within the indications for endoscopic resection. It is a simple procedure that enables easy and complete resection of DNETs without complications.
直径小于1厘米且未侵犯固有肌层的十二指肠神经内分泌肿瘤（DNETs）转移风险较低。因此，DNETs常通过内镜切除。然而，在各种手术方法中，就可行性、有效性和简便性而言，最适合DNETs的方法尚不清楚。
回顾性研究2003年5月至2020年12月在神奈川癌症中心接受使用结扎装置的内镜黏膜下切除术（ESMR-L）的DNETs患者，以评估其临床特征以及短期和长期预后。
连续11例患者的12个病变接受了12次ESMR-L治疗。患者发现病变时的中位年龄为68岁（范围50 - 83岁）。1例患者在首次ESMR-L治疗时存在2个病变。12个病变中的11个（91.7%）位于十二指肠球部，其中10个（83.3%）在前壁，其余1个（8.3%）位于十二指肠降部。整块切除率和R0切除率分别为100%和75%。出血率和穿孔率均为0%。在4例非根治性切除的患者中，2例在ESMR-L后接受了额外手术。1例患者有局部残留肿瘤，另1例有淋巴结转移。在局部残留肿瘤的病例中，ESMR-L标本的垂直切缘为阳性。回顾性分析，这种情况下O形环结扎不充分。所有患者在中位随访期5.7年期间均无复发。
在适合内镜切除的指征范围内，ESMR-L最适合DNETs。它是一种简单的手术方法，能够轻松、完整地切除DNETs且无并发症。
