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Present Status of Endoscopic Submucosal Dissection for Non-Ampullary Duodenal Epithelial Tumors

Clinical Endoscopy 2020년 53권 6호 p.652 ~ 658
Kakushima Naomi, Yoshida Masao, Yabuuchi Yohei, Kawata Noboru, Takizawa Kohei, Kishida Yoshihiro, Ito Sayo, Imai Kenichiro, Hotta Kinichi, Ishiwatari Hirotoshi, Matsubayashi Hiroyuki, Ono Hiroyuki,
소속 상세정보
 ( Kakushima Naomi ) - Shizuoka Cancer Center Division of Endoscopy
 ( Yoshida Masao ) - Shizuoka Cancer Center Division of Endoscopy
 ( Yabuuchi Yohei ) - Shizuoka Cancer Center Division of Endoscopy
 ( Kawata Noboru ) - Shizuoka Cancer Center Division of Endoscopy
 ( Takizawa Kohei ) - Shizuoka Cancer Center Division of Endoscopy
 ( Kishida Yoshihiro ) - Shizuoka Cancer Center Division of Endoscopy
 ( Ito Sayo ) - Shizuoka Cancer Center Division of Endoscopy
 ( Imai Kenichiro ) - Shizuoka Cancer Center Division of Endoscopy
 ( Hotta Kinichi ) - Shizuoka Cancer Center Division of Endoscopy
 ( Ishiwatari Hirotoshi ) - Shizuoka Cancer Center Division of Endoscopy
 ( Matsubayashi Hiroyuki ) - Shizuoka Cancer Center Division of Endoscopy
 ( Ono Hiroyuki ) - Shizuoka Cancer Center Division of Endoscopy

Abstract


Prediction of histology by endoscopic examination is important in the clinical management of non-ampullary duodenal epithelial tumors (NADETs), including adenoma and adenocarcinoma. The use of a simple scoring system based on the findings of white-light endoscopy or magnified endoscopy with narrow-band imaging is useful to differentiate between Vienna category 3 (C3) and C4/5 lesions. Less invasive endoscopic resection procedures, such as cold snare polypectomy, are quick to perform and convenient for small (<10 mm) C3 lesions. Neoplasms with higher grade histology, such as C4/5 lesions, should be treated by endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), or surgery. Although EMR often requires piecemeal resection, the complication rate is acceptable. Excellent complete resection rates could be achieved by ESD; however, it remains a challenging method considering the high risk of complications. Shielding or closure of the ulcer after ESD is effective at decreasing the risk of delayed bleeding and perforation. Laparoscopic endoscopic cooperative surgery is an ideal treatment with a high rate of en bloc resection and a low rate of complications, although it is limited to high-volume centers. Patients with NADETs could benefit from a multidisciplinary approach to stratify the optimal treatment based on endoscopic diagnoses.

키워드

Endoscopic mucosal resection; Endoscopic submucosal dissection; Laparoscopic endoscopic cooperative surgery; Nonampullary duodenal epithelial tumors

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