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Digestive Endoscopy : Official Journal... Mar 2014Perforation is a major complication of endoscopic resection for gastrointestinal neoplasms. However, little is known about delayed perforation after endoscopic resection...
BACKGROUND
Perforation is a major complication of endoscopic resection for gastrointestinal neoplasms. However, little is known about delayed perforation after endoscopic resection for non-ampullary duodenal neoplasm. The aim of the present study was to investigate the clinical features of delayed perforation after endoscopic resection for non-ampullary duodenal neoplasm.
PATIENTS AND METHODS
This was a retrospective cohort study conducted in a referral cancer center. A total of 63 patients (41 with adenomas and 22 with carcinomas) underwent endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) from January 1993 to December 2011. Incidence, outcome, and factors associated with occurrence of delayed perforation were investigated.
RESULTS
Delayed perforation occurred in four patients (6.3%). All lesions were located distal to Vater's ampulla. Three of four delayed perforations occurred within 36 h after endoscopic resection. All patients developed retroperitonitis, and two also had retroperitoneal abscesses. Although three patients were cured with conservative management, a long hospital stay was required (28-, 80-, and 81-day hospital stay, respectively). One patient required emergency surgery as a result of panperitonitis. There was, fortunately, no mortality in this series. The significant predictors of delayed perforation were location (distal to Vater's ampulla, P = 0.007) and resection method (ESD and piecemeal EMR, P = 0.003).
CONCLUSION
Endoscopic resection for non-ampullary duodenal neoplasms has a possible risk of morbid complication i.e. delayed perforation, especially in patients with lesions located on the side distal from the ampulla and who are treated with piecemeal EMR or ESD.
Topics: Adult; Duodenal Neoplasms; Duodenum; Endoscopy, Gastrointestinal; Female; Follow-Up Studies; Humans; Incidence; Intestinal Mucosa; Intestinal Perforation; Japan; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Rupture, Spontaneous; Time Factors; Tomography, X-Ray Computed
PubMed: 23621427
DOI: 10.1111/den.12104 -
Chirurgia (Bucharest, Romania : 1990) 2010Carcinoid tumors of the duodenum are extremely rare. We present two cases (observation) of duodenal carcinoid tumors. The main clinical manifestation in both cases was...
Carcinoid tumors of the duodenum are extremely rare. We present two cases (observation) of duodenal carcinoid tumors. The main clinical manifestation in both cases was upper GI tract hemorrhage associated to severe anemia.The tumors were high dimension (2.5 cm and 6.5 cm respectively) and were discovered by upper GI endoscopy. First observation presented a lymph node metastasis and the second one a massive invasion of the pancreas. In both cases the diagnosis was precised only postoperatively, through histological and immunohistochemical analisys. In the first observation we performed local transduodenal resection and in the second one cephalic duodenopancreatectomy. After six months we had a reintervention at the first case for a retroduodenal carcinoid tumoral reoccurrence--extirpation completed with total gastrectomy for neuroendocrine carcinoma. Despite the locoregional aspect of advanced evolution of the disease, the long-term evolution of the patient was satisfactory. Both patients are alive 42 months respectively 15 months after the operation. Carcinoid tumors of the duodenum are indolent and their impact on survival is uncertain.
Topics: Adult; Carcinoid Tumor; Diagnosis, Differential; Duodenal Neoplasms; Female; Gastrectomy; Humans; Middle Aged; Neoplasm Recurrence, Local; Pancreaticoduodenectomy; Treatment Outcome
PubMed: 20941980
DOI: No ID Found -
World Journal of Gastroenterology Nov 2015Superficial non-ampullary duodenal epithelial tumor (SNADET) is defined as a sporadic tumor that is confined to the mucosa or submucosa that does not arise from Vater's... (Review)
Review
Superficial non-ampullary duodenal epithelial tumor (SNADET) is defined as a sporadic tumor that is confined to the mucosa or submucosa that does not arise from Vater's papilla, and it includes adenoma and adenocarcinoma. Recent developments in endoscopic technology, such as high-resolution endoscopy and image-enhanced endoscopy, may increase the chances of detecting SNADET lesions. However, because SNADET is rare, little is known about its preoperative endoscopic diagnosis. The use of endoscopic resection for SNADET, which has no risk of metastasis, is increasing, but the incidence of complications, such as perforation, is significantly higher than in any other part of the digestive tract. A preoperative diagnosis is required to distinguish between lesions that should be followed up and those that require treatment. Retrospective studies have revealed certain endoscopic findings that suggest malignancy. In recent years, several new imaging modalities have been developed and explored for real-time diagnosis of these lesion types. Establishing an endoscopic diagnostic tool to differentiate between adenoma and adenocarcinoma in SNADET lesions is required to select the most appropriate treatment. This review describes the current state of knowledge about preoperative endoscopic diagnosis of SNADETs, such as duodenal adenoma and duodenal adenocarcinoma. Newer endoscopic techniques, including magnifying endoscopy, may help to guide these diagnostics, but their additional advantages remain unclear, and further studies are required to clarify these issues.
Topics: Adenocarcinoma; Biopsy; Diagnosis, Differential; Duodenal Neoplasms; Duodenoscopy; Humans; Image Enhancement; Narrow Band Imaging; Neoplasm Staging; Predictive Value of Tests; Preoperative Care; Reproducibility of Results
PubMed: 26557007
DOI: 10.3748/wjg.v21.i41.11832 -
Deutsche Medizinische Wochenschrift... Nov 1991
Review
Topics: Aged; Diagnosis, Differential; Duodenal Neoplasms; Endoscopy; Humans; Middle Aged; Neoplasm Metastasis; Palliative Care; Prognosis; Tomography, X-Ray Computed
PubMed: 1720375
DOI: 10.1055/s-2008-1063828 -
Digestive Endoscopy : Official Journal... Apr 2014Duodenal adenomatosis is the most frequent extracolonic manifestation of familial adenomatous polyposis (FAP), and duodenal cancer has been assumed to be the second most...
Duodenal adenomatosis is the most frequent extracolonic manifestation of familial adenomatous polyposis (FAP), and duodenal cancer has been assumed to be the second most significant cause of death in patients with the disease. To stratify the risk of duodenal cancer, Spigelman's classification was proposed for the staging of duodenal adenomatosis. According to Western guidelines, patients with stage IV of the classification are candidates for prophylactic duodenectomy. Since our institutional experience disclosed only 2% of duodenal or ampullary cancers among 130 patients with FAP, and because most duodenal adenomatosis remains unchanged under endoscopic surveillance, it seems likely that aggressive endoscopic or surgical removal is unnecessary for most FAP patients with duodenal adenomatosis. In the present article, we demonstrate our data and present our strategy for duodenal adenomatosis of FAP.
Topics: Adenomatous Polyposis Coli; Adenomatous Polyps; Adolescent; Adult; Age Distribution; Aged; Biopsy, Needle; Child; Cohort Studies; Comorbidity; Duodenal Neoplasms; Duodenoscopy; Female; Humans; Immunohistochemistry; Incidence; Japan; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Retrospective Studies; Sex Distribution; Young Adult
PubMed: 24750145
DOI: 10.1111/den.12255 -
Journal of Gastrointestinal Surgery :... 2003Benign duodenal neoplasms (BDNs) are uncommon, and their optimal management remains undefined. We analyzed all cases of BDN treated at our institution during a 10-year...
Benign duodenal neoplasms (BDNs) are uncommon, and their optimal management remains undefined. We analyzed all cases of BDN treated at our institution during a 10-year period (January 1990 through January 2000). Data are expressed as median (range). Sixty-two patients were treated for BDNs. The results of histologic examination of their lesions were as follows: 36 adenomas, eight Brunner's gland tumors, 10 inflammatory polyps, two hamartomas, and six others. Forty-seven patients were treated nonoperatively, and 15 patients underwent surgery. Lesion characteristics leading to surgical intervention included large polyp diameter and submucosal penetration detected on endoscopic ultrasound imaging. There were no treatment-related deaths. Major morbidity occurred in 2% of patients who underwent endoscopic resection and in 33% of patients who underwent surgery (P = 0.002). Among patients treated for adenomas, seven (19.4%) had a recurrence at a median of 12 (4 to 48) months. Most BDNs can be managed with minimal morbidity using endoscopic techniques. Systematic follow-up of patients treated for adenomas is required.
Topics: Adenoma; Adenomatous Polyposis Coli; Adult; Aged; Aged, 80 and over; Algorithms; Brunner Glands; Duodenal Neoplasms; Endosonography; Female; Humans; Intestinal Polyps; Male; Middle Aged; Neoplasm Recurrence, Local; Retrospective Studies
PubMed: 12763412
DOI: 10.1016/S1091-255X(02)00146-4 -
Journal of Clinical Pathology Nov 2006Bi-allelic germline mutations in the MUTYH gene give rise to multiple adenomas and an increased incidence of colorectal cancer. In addition, duodenal adenomas and other...
Bi-allelic germline mutations in the MUTYH gene give rise to multiple adenomas and an increased incidence of colorectal cancer. In addition, duodenal adenomas and other extra-colonic manifestations have been described in MUTYH-associated polyposis (MAP) patients. We describe two patients with bi-allelic MUTYH gene mutations with duodenal carcinoma. The tumour in Patient A was detected during evaluation of non-specific abdominal complaints. Patient B was already diagnosed with tens of adenomas and a colon carcinoma, when a duodenal neoplasm was detected. The identification of somatic G>T mutations in codon 12 of the K-RAS2 gene provides evidence that the duodenal lesions were induced by MUTYH deficiency. Studies in larger series of MAP patients are needed to investigate the risk of upper-gastro-intestinal malignancies and to determine further guidelines for endoscopical surveillance.
Topics: Adenomatous Polyposis Coli; Aged; DNA Glycosylases; DNA Mutational Analysis; DNA, Neoplasm; Duodenal Neoplasms; Germ-Line Mutation; Humans; Male; Middle Aged
PubMed: 16943222
DOI: 10.1136/jcp.2005.031757 -
The American Surgeon May 2016Duodenal neuroendocrine tumors (NETs) are rare. Historically, when feasible a less aggressive surgical approach is considered. The aim of this study was to identify...
Duodenal neuroendocrine tumors (NETs) are rare. Historically, when feasible a less aggressive surgical approach is considered. The aim of this study was to identify factors associated with prognosis and the necessity for more aggressive surgical procedures. All patients who underwent surgery for duodenal NETs between September 2005 and June 2014 were identified retrospectively. Data collected included clinical presentation, operative findings, and histopathological data. Eighteen patients underwent surgical management for duodenal NETs. Two patients underwent transduodenal excision (11%), two patients had partial duodenal resection (11%), two patients had antrectomy including 1st part of duodenum (D1) resection (33%), and eight underwent pancreaticoduodenectomy [PD (44%)]. On analysis, 2nd part of duodenum (D2) location was the most common site of duodenal NETs (n = 9, 50%). The odds of having a PD were 10 times higher when the lesion was in D2 location. The odds of having a positive lymph node are nine times higher when the lesion is in D2 region. The odds of having a positive lymph node are three times higher when lesion is greater than T1. D2 location of NETs is associated with higher odds of lymph node positivity and need for more extensive procedures like PD.
Topics: Adult; Aged; Aged, 80 and over; Biopsy, Needle; Cohort Studies; Disease-Free Survival; Duodenal Neoplasms; Female; Humans; Immunohistochemistry; Intestinal Mucosa; Male; Middle Aged; Neoplasm Invasiveness; Neuroendocrine Tumors; Prognosis; Retrospective Studies; Risk Assessment; Survival Analysis; Treatment Outcome
PubMed: 27215716
DOI: No ID Found -
Surgical Endoscopy Jul 2022Sporadic non-ampullary duodenal adenomas (SNDAs) are often referred to tertiary centers because of the challenges in endoscopic resection. There is a paucity of data on...
BACKGROUND AND AIMS
Sporadic non-ampullary duodenal adenomas (SNDAs) are often referred to tertiary centers because of the challenges in endoscopic resection. There is a paucity of data on both technical and clinical outcomes. The aim of our study was to evaluate the efficacy and safety of endoscopic resection for the treatment of SNDA in two western centers.
METHODS
This is a retrospective study reporting data of a cohort of patients referred for resection of SNDA between 2013 and 2017. Patients with familial adenomatous polyposis or ampullary lesions were excluded from present analysis. Outcomes considered for this study were technical success, adverse events, recurrence and need for surgery.
RESULTS
120 patients (mean age 66 ± 11.9 years, 64male) were enrolled in the study. Mean size of the lesions was 23.3 mm (range 5-80). Fifty-six en-bloc endoscopic mucosal resection (EMR) (46.6%), 41 piecemeal EMR (pEMR) and 23 endoscopic submucosal dissection were performed. Intra-procedural perforation was observed in 4 patients (3.3%). Fourteen post-procedural (11.6%) adverse events were recorded. All post-procedural perforations occurred in lesions > 30 mm. Recurrence was observed in 11 patients (9.5%) during a mean follow-up of 29 months. All recurrences were successfully managed endoscopically. 119 patients were still alive at last follow-up.
CONCLUSION
Endoscopic resection can be successfully carried out in majority of patients. Size > 30 mm seems to be the predictor of high adverse events risk.
Topics: Adenoma; Aged; Duodenal Neoplasms; Duodenum; Endoscopic Mucosal Resection; Humans; Middle Aged; Neoplasm Recurrence, Local; Retrospective Studies; Treatment Outcome
PubMed: 34993587
DOI: 10.1007/s00464-021-08900-5 -
Digestive Diseases (Basel, Switzerland) 2023Neuroendocrine neoplasms of the ampulla of Vater (ampullary NEN) have features of both gastrointestinal and pancreato-biliary (PB) NEN. However, the limited number of...
BACKGROUND
Neuroendocrine neoplasms of the ampulla of Vater (ampullary NEN) have features of both gastrointestinal and pancreato-biliary (PB) NEN. However, the limited number of studies examining ampullary NEN makes it difficult to clarify their unique characteristics. This study aimed to elucidate the clinical characteristics of ampullary NEN.
METHODS
We enrolled 162 patients with PB-NEN diagnosed at Kyushu University Hospital between 2011 and 2020. Clinical features, pathological diagnoses, treatments, and prognoses were retrospectively analyzed. We also compared ampullary NEN with pancreatic NEN (PanNEN).
RESULTS
We analyzed 10 ampullary NEN cases and 149 PanNEN cases. The ampullary NEN cases consisted of 4 cases of neuroendocrine tumor Grade 1 (NET G1), 1 NET G2 (Grade 2), and 5 neuroendocrine carcinomas (NECs). The incidences of NEC and cholangitis were significantly higher in ampullary NEN than in PanNEN. All ampullary NETs had a submucosal tumor-like appearance, as identified by endoscopic ultrasound-guided fine needle aspiration. We treated small NET G1 (<10 mm) with endoscopic papillectomy and large NET G1 with pancreaticoduodenectomy. There were no cases of recurrence after resection. All ampullary NECs presented with the characteristic endoscopic finding of a "crater sign" similar to deep-mining ulcers seen in gastric malignant lymphoma. Four cases underwent surgical resection, and 1 case was unresectable. Two patients who underwent multidisciplinary treatment were maintained without recurrence for over 2 years.
CONCLUSIONS
Endoscopic findings showed identifiable distinctions between ampullary NETs and NECs.
Topics: Humans; Retrospective Studies; Neuroendocrine Tumors; Prognosis; Pancreaticoduodenectomy; Duodenal Neoplasms; Pancreatic Neoplasms
PubMed: 35588707
DOI: 10.1159/000525013