Future directions of duodenal endoscopic submucosaldissection

• 作者: Hiroyuki Miyatani Satohiro Matsumoto Yukio Yoshida
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: DUODENAL TUMOR ENDOSCOPIC submucosaldissection Cancer ADENOMA NEUROENDOCRINE TUMOR Technical KNOW-HOW Complication ENDOSCOPIC mucosalresection
• 年，卷（期）: 2015,（4）
• 页码范围: 389-395
• 页数: 7页
• 分类号: R

摘要

Endoscopic therapies for lesions of the duodenumare technically more difficult than those for lesionsof the other parts of the gastrointestinal tract due tothe anatomical features of the duodenum, and theincidence rate of complications such as perforation andbleeding is also higher. These aforementioned trendswere especially noticeable for the case of duodenalendoscopic submucosal dissection （ESD）. The indicationfor ESD of duodenal tumors should be determinedby assessment of the histopathology, macroscopicmorphology, and diameter of the tumors. The threetypes of candidate lesions for endoscopic therapy areadenoma, carcinoma, and neuroendocrine tumors. Forapplying endoscopic therapies to duodenal lesions,accurate preoperative histopathological diagnosisis necessary. The most important technical issue induodenal ESD is the submucosal dissection process.In duodenal ESD, a short needle-type knife is suitablefor the mucosal incision and submucosal dissectionprocesses, and the Small-caliber-tip Transparent hoodis an important tool. After endoscopic therapies, thewound should be closed by clipping in order to preventcomplications such as secondary hemorrhage anddelayed perforation. At present, the criteria for selectionbetween ESD and EMR vary among institutions. Theindications for ESD should be carefully considered.Duodenal ESD should have limitations, such as theneed for its being performed by experts with abundantexperience in performing the procedure.