Endoscopic combined removal of tubulovillous tumor of the descending duodenum

Duodenal tumors (duodenal tumors) are rare neoplasms of the gastrointestinal tract and are characterized by significant clinical and pathological heterogeneity. Depending on the phenotype of mucin, intestinal and gastric types of tumor lesions are distinguished, differing in localization, risks of submucosal invasion and lymphogenic metastasis. The most common malignant neoplasm of the duodenum is adenocarcinoma, with tumors predominantly localized in the descending intestine. The choice of therapeutic tactics depends on the size of the formation, the depth of invasion and the involvement of vascular structures, while endoscopic removal methods are widely used in the early stages of the disease. Objective: to demonstrate the possibilities of a combined endoscopic approach (EMR and ESD) for the removal of a nonampular tubulo-villous tumor of the descending part of the duodenum. Materials and methods: a clinical case of a 67-year-old patient with epithelial formation of the descending part of the duodenum up to 30 mm in size, revealed by esophagogastroduodenoscopy, is presented. According to the radiation examination methods, no signs of transmural growth were detected. Initially, submucosal dissection was performed, complicated by intraoperative bleeding, and therefore the tactics were changed to endoscopic resection of the mucous membrane. Results: The tumor was removed fragmentarily within the unchanged mucous membrane. The removal was accompanied by active bleeding. Hemostasis was successfully achieved using coagulation, local administration of epinephrine, and systemic hemostatic therapy. According to the pathological and anatomical examination, tubulo-villous adenoma with foci of severe epithelial dysplasia was diagnosed. No complications were noted in the postoperative period, and control endoscopic examinations revealed complete epithelialization of the resection area.

nonampular tumors of the duodenum, tubulo-villous adenoma, duodenal adenoma, endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD)

1. Goldner B., Stabile B.E. Duodenal adenocarcinoma: why the extreme rarity of duodenal bulb primary tumors? Am Surg. 2014 Oct;80(10):956-9. PMID: 25264638.

2. Tsuji S., Doyama H., Tsuji K. et al. Preoperative endoscopic diagnosis of superficial non-ampullary duodenal epithelial tumors, including magnifying endoscopy. World J Gastroenterol. 2015 Nov 7;21(41):11832-41. doi: 10.3748/wjg.v21.i41.11832.

3. Mitsuishi T., Hamatani S., Hirooka S. et al. Clinicopathological characteristics of duodenal epithelial neoplasms: Focus on tumors with a gastric mucin phenotype (pyloric gland-type tumors). PLoS One. 2017 Apr 4;12(4): e0174985. doi: 10.1371/journal.pone.0174985.

4. Sawada R., Kimoto Y., Furuta K. et al. Gastric-type duodenal neoplasms with rapid growth: A report of two cases. DEN Open. 2022 Dec 23;3(1): e197. doi: 10.1002/deo2.197.

5. Hu X., Aivazian K., McKenzie C., Wong M., Kaffes A., Saxena P. A Rare Case of Duodenal Adenocarcinoma Presenting as a Subepithelial Lesion in a Patient Undergoing Investigation for Iron Deficiency Anaemia. Case Rep Gastrointest Med. 2019 Oct 7;2019:3434620. doi: 10.1155/2019/3434620.

6. Popova E.S., Agbalyan A.N., Titov V.D. et al. Case report of the patient with four multiple primary malignant tumors in the duodenum and colon. Bulletin of RSMU. 2025; (3): 53-6. (in Russ.) doi: 10.24075/brsmu.2025.028.@@ Попова Е.С., Агбалян А.Н., Титов В.Д. и др. Клиническое наблюдение пациента с четырьмя первично-множественными злокачественными опухолями двенадцатиперстной и толстой кишки. Вестник РГМУ. 2025; (3): 58-62. doi: 10.24075/vrgmu.2025.028.

7. ang S., Li X., Wu A. Poorly cohesive duodenal carcinoma mixed with signet ring cell carcinoma with systemic metastasis: a case report and literature review. Front Oncol. 2023 Aug 24;13:1240013. doi: 10.3389/fonc.2023.1240013.