Formidable complication of endoscopic submucosal dissection in the duodenum
Abstract
Duodenal adenomas are relatively uncommon neoplasms in the general population. They are traditionally treated surgically but with a high injury and mortality rate. Endoscopic methods are increasingly being used for treatment of epithelial tumors of the duodenum. Despite an extensive use of the endoscopic submucosal dissection in esophagus, stomach and colon, the implementation of this treatment in duodenum is significantly less spread because of often arising complications. However this method significantly reduces the relapse rate associated with piecemeal endoscopic resection. In a clinical case study we show complication in a 72 year old patient after the resection of a duodenal adenoma using endoscopic submucosal dissection method. On the first day after the procedure necrosis occurs in place where the dissection was. The perforation zone which was situated on the wall opposite to major duodenal papilla and occupied the half of intestine circumference was removed by formation of duodenojejunum anastomosis. On the 12-th day after this emergency surgery the patient was released in satisfactory condition. The perforation rate after endoscopic submucosal dissection in duodenum reaches 50%. An endoscopic method can be used for treatment of neoplasms in duodenum but patient should be well informed of risks and complications after this manipulation. Therefore, surgeons and endoscopists should cooperate closely in case of complications.
About the Authors
U. V. Petrik
State Research Institute of Oncology named after NN Petrov
Russian Federation
Russian Federation
O. B. Tkachenko
State Research Institute of Oncology named after NN Petrov
Russian Federation
Russian Federation
A. M. Sherbakov
State Research Institute of Oncology named after NN Petrov
Russian Federation
Russian Federation
U. V. Pelipas
State Research Institute of Oncology named after NN Petrov
Russian Federation
Russian Federation
M. V. Grinkevich
State Research Institute of Oncology named after NN Petrov
Russian Federation
Russian Federation
O. V. Beloglazova
State Research Institute of Oncology named after NN Petrov
Russian Federation
Russian Federation
A. N. Sidorova
State Research Institute of Oncology named after NN Petrov
Russian Federation
Russian Federation
References
1. Peter М Y Goh, M.D. and Jorge Е Lenzi, M.D. Benign tumors of the duodenum and stomach. Surgical Treatment: Evidence-Based and Problem-Oriented. Munich: Zuckschwerdt; 2001
2. Conio M, De Ceglie A, Filiberti R, Fisher D.A, Siersema P.D. Cap-assisted EMR of large, sporadic, nonampullary duodenal polyps. Gastrointest Endosc. 2012;76:1160-1169.
3. Jepsen J.M, Persson M, Jakobsen N.O, Christiansen T, Skoubo-Kristensen E, Funch-Jensen P, Kruse A, Thommesen P. Prospective study of prevalence and endoscopic and histopathologic characteristics of duodenal polyps in patients submitted to upper endoscopy. Scand J Gastroenterol. 1994;29:483-487.
4. Culver E.L, Mc Intyre A.S. Sporadic duodenal polyps: classification, investigation, and management. Endoscopy. 2011:43:144-155.
5. Basford P.J, Bhandari P. Endoscopic management of nonampullary duodenal polyps. Therap Adv Gastroenterol. 2012;5:127-138.
6. Basford P.J, George R, Nixon E, Chaudhuri T, Mead R, Bhandari P. Endoscopic resection of sporadic duodenal adenomas: comparison of endoscopic mucosal resection (EMR) with hybrid endoscopic submucosal dissection (ESD) techniques and the risks of late delayed bleeding. Surg Endosc. 2014;28:1594-1600.
7. Apel D, Jakobs R, Spiethoff A, Riemann J.F. Follow-up after endoscopic snare resection of duodenal adenomas. Endoscopy. 2005;37:444-448.
8. Ahmad N.A, Kochman M.L, Long W.B, Furth E.E, Ginsberg G.G. Efficacy, safety, and clinical outcomes of endoscopic mucosal resection: a study of 101 cases. Gastrointest Endosc. 2002;55:390-396.
9. Kedia P, Brensinger C, Ginsberg G. Endoscopic predictors of successful endoluminal eradication in sporadic duodenal adenomas and its acute complications. Gastrointest Endosc. 2010;72:1297-1301.
10. Kim H.K, Chung W.C, Lee B.l, Cho Y.S. Efficacy and long-term outcome of endoscopic treatment of sporadic nonampullary duodenal adenoma. Gut Liver. 2010;4:373-377.
11. Flonda T, Yamamoto F.I, Osawa H, Yoshizawa M, Nakano F.I, Sunada K, Flanatsuka K, Sugano K. Endoscopic submucosal dissection for superficial duodenal neoplasms. Dig Endosc. 2009;21:270-274
12. Galandiuk S, Flermann R.E, Jagelman D.G, Fazio V.W, Sivak M.V. Villous tumors of the duodenum. Ann Surg. 1988;207:234-239
13. Farnell M.B, Sakorafas G.H, Sarr M.G, Rowland C.M, Tsiotos G.G, Farley D.R, Nagorney D.M. Villous tumors of the duodenum: reappraisal of local vs. extended resection. J Gastrointest Surg. 2000;4:13-21, discussion 22-23.
14. Oka S, Tanaka S, Nagata S, Hiyama T, Ito M, Kitadai Y, Yoshihara M, Flaruma K, Chayama K. Clinicopathologic features and endoscopic resection of early primary nonampullary duodenal carcinoma. J Clin Gastroenterol. 2003;37:381-386.
15. Flirasawa R, lishi F.I, Tatsuta M, Ishiguro S. Clinicopathologic features and endoscopic resection of duodenal adenocarcinomas and adenomas with the submucosal saline injection technique. Gastrointest Endosc. 1997;46:507-513.
16. Haubrich W.S, Johnson R.B, Foroozan P. Endoscopic removal of a duodenal adenoma. Gastrointest Endosc. 1973; 19:201.
17. Lepilliez V, Chemaly M, Ponchon T, Napoleon B, Saurin J.C. Endoscopic resection of sporadic duodenal adenomas: an efficient technique with a substantial risk of delayed bleeding. Endoscopy. 2008;40:806-810.
18. Alexander S, Bourke M.J, Williams S.J, Bailey A, Co J. EMR of large, sessile, sporadic nonampullary duodenal adenomas: technical aspects and long-term outcome (with videos) Gastrointest Endosc. 2009;69:66-73.
19. Perez A, Saltzman J.R, Carr-Locke D.L, Brooks D.C, Osteen R.T, Zinner M.J, Ashley S.W, Whang E.E. Benign nonampullary duodenal neoplasms. J Gastrointest Surg. 2000;7:536-541.
20. Oka S, Tanaka S, Kaneko I, Mouri R, Hirata M, Kawamura T, Yoshihara M, Chayama K. Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest Endosc. 2006;64:877-883.
21. Shinoda M, Makino A, Wada M, Kabeshima Y, Takahashi T, Kawakubo F.I, Shito M, Sugiura F.I, Omori T. Successful endoscopic submucosal dissection for mucosal cancer of the duodenum. Dig Endosc. 2010;22:49-52.
22. Floteya Y.N, lizuka T, Kikuchi D, Mitani T, Matsui A, Ogawa O, Yamashita S, Furuhata T, Yamada A, Kimura R, et al. Endoscopic submucosal dissection for nonampullary large superficial adenocarcinoma/adenoma of the duodenum: feasibility and long-term outcomes. Endoscopy.International Open. 2013:E2-E7.
23. Endo M, Abiko Y, Oana S, Kudara N, Chiba T, Suzuki K, Koizuka F.I, Uesugi N, Sugai T. Usefulness of endoscopic treatment for duodenal adenoma. Dig Endosc. 2010;22:360-365.
24. Takahashi T, Ando T, Kabeshima Y, Kawakubo FI, Shito M, Sugiura F.I, Omori T. Borderline cases between benignancy and malignancy of the duodenum diagnosed successfully by endoscopic submucosal dissection. Scand J Gastroenterol. 2009;44:1377-1383.
25. Jung J.F.H, Choi K.D, Ahn J.Y, Lee'J.FI, Jung F.I.Y, Choi K.S, Lee G.F.H, Song H.J, Kim D.H, Kim M.Y, et al. Endoscopic submucosal dissection for sessile, nonampullary duodenal adenomas. Endoscopy. 2013;45:133-135.
26. Inoue T, Uedo N, Yamashina T, Yamamoto S, Hanaoka N, Takeuchi Y, Fligashino K, Ishihara R, lishi F.I, Tatsuta M, et al. Delayed perforation: a hazardous complication of endoscopic resection for non-ampullary duodenal neoplasm. Dig Endosc. 2014;26:220-227
Review
For citations:
Petrik U.V., Tkachenko O.B., Sherbakov A.M., Pelipas U.V., Grinkevich M.V., Beloglazova O.V., Sidorova A.N. Formidable complication of endoscopic submucosal dissection in the duodenum. Filin’s Clinical endoscopy. 2017;(1):70-74. (In Russ.)
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