Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai, 200032, China.
Surg Endosc. 2023 Aug;37(8):6135-6144. doi: 10.1007/s00464-023-10013-0. Epub 2023 May 5.
To evaluate the effectiveness and safety of endoscopic resection and various suturing methods to treat non-ampullary duodenal submucosal tumors (NAD-SMTs).
We performed a retrospective observational study of patients with NAD-SMTs who underwent endoscopic resection at Zhongshan Hospital, Fudan University, China, between June 2017 and December 2020. Data on patient characteristics, treatments and follow-up results were collected. The association between clinicopathologic characteristics and different suturing methods or adverse events were analyzed.
Of 128 patients analyzed, 26 underwent endoscopic mucosal resection (EMR), 64 underwent endoscopic submucosal excavation (ESE), and 38 underwent endoscopic full-thickness resection (EFTR). EMR and ESR are both appropriate for non-full-thickness lesions, whereas ESE is more appropriate for tumors located in the bulb or descending duodenum. Gastric tube drainage is more strongly recommended after ESE. Satisfactory suturing is also vital endoscopic resection of NAD-SMTs. Metallic clips are often used in EMR or ESE of non-full-thickness lesions. The pathological findings revealed that the full-thickness lesions were predominantly gastrointestinal stromal tumors (GIST), Brunner's tumor or lipoma, and the surgeons usually used purse-string sutures to close the wounds. The operation time was longer for purse-string suture closure than metallic clip closure. Eleven patients had complications. Risk factors for adverse events included large-diameter tumor (≥ 2 cm), location in the descending part of the duodenum, involvement of the fourth layer of the duodenal wall, EFTR, and GIST.
Endoscopic resection of NAD-SMTs is effective but is associated with a high incidence of complications due to their anatomical peculiarities. Preoperative diagnosis is quite important. Careful selection of treatment and suturing methods are necessary to reduce the risk of adverse effects. Given the increased frequency of severe complications during or following duodenal endoscopic resection, this procedure should be performed by experienced endoscopists.
评估内镜切除和各种缝合方法治疗非壶腹十二指肠黏膜下肿瘤（NAD-SMTs）的有效性和安全性。
我们对 2017 年 6 月至 2020 年 12 月在中国复旦大学中山医院接受内镜下切除 NAD-SMTs 的患者进行了回顾性观察性研究。收集了患者特征、治疗和随访结果的数据。分析了临床病理特征与不同缝合方法或不良事件之间的关系。
在 128 例患者中，26 例行内镜黏膜切除术（EMR），64 例行内镜黏膜下挖除术（ESE），38 例行内镜全层切除术（EFTR）。EMR 和 ESR 均适用于非全层病变，而 ESE 更适用于位于球部或降部的肿瘤。ESE 后更强烈推荐胃管引流。满意的缝合也是 NAD-SMTs 内镜切除的关键。金属夹通常用于 EMR 或 ESE 的非全层病变。病理结果显示，全层病变主要为胃肠道间质瘤（GIST）、布伦纳瘤或脂肪瘤，外科医生通常使用荷包缝合关闭伤口。荷包缝合关闭的手术时间长于金属夹闭合。11 例患者出现并发症。不良事件的危险因素包括大直径肿瘤（≥2cm）、降部位置、累及十二指肠壁第 4 层、EFTR 和 GIST。
由于 NAD-SMTs 的解剖学特点，内镜切除是有效的，但与较高的并发症发生率相关。术前诊断非常重要。为了降低不良反应的风险，需要仔细选择治疗和缝合方法。由于十二指肠内镜切除术中或术后严重并发症的频率增加，该手术应由经验丰富的内镜医生进行。
