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Endoscopic full-thickness resection of duodenal lesions (with video)

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Abstract

Background and aim

The endoscopic treatment of non-lifting or submucosal duodenal lesions is associated with a high risk of incomplete resection and adverse events. Clip-assisted endoscopic full-thickness resection (EFTR) is a new approach for en bloc removal of neoplastic lesions in the GI tract. The aim of this study was to investigate its efficacy and safety in the duodenum.

Materials and methods

We retrospectively collected all consecutive patients with duodenal lesions who underwent EFTR with OTSC (Ovesco Endoscopy, Tübingen, Germany) or the new full-thickness resection device (FTRD; Ovesco Endoscopy, Tübingen, Germany). Complete resection rate was defined as histologically-verified R0 resection. Main endoscopic and clinical outcomes (technical success, rate of EFTR, adverse events) were systematically assessed at 3 and 6 months.

Results

Between May 2017 and January 2019, 10 patients with duodenal lesions underwent EFTR (5 non-lifting adenomas, 2 adenomas recurrence/relapse and 3 subepithelial tumours). Technical success was overall achieved in 8/10 cases (80%). The two FTRD failed cases were completed with snare resection. The complete full-thickness resection rate was achieved in 8/10 (80%), while in two cases it was limited to mucosal or submucosal layer. R0 resection rate was achieved in 8/10 (80%) patients. The mean procedure time was 75 min (range 53–120 min). There were no major adverse events. At 3 and 6-month follow-up, no recurrence was observed.

Conclusions

Clip-assisted EFTR is a feasible and effective technique for en bloc resection of “difficult” superficial neoplasia and submucosal lesions in the duodenum, representing another technique that must be part of the endoscopist’s armamentarium.

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Authors and Affiliations

  1. Digestive Endoscopy Unit, Campus Bio-Medico, University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy

    Gianluca Andrisani & Francesco Maria Di Matteo

Authors
  1. Gianluca Andrisani
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  2. Francesco Maria Di Matteo
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Correspondence to Gianluca Andrisani.

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Gianluca Andrisani and Francesco Maria Di Matteo have no conflicts of interest or financial ties to disclose.

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464_2019_7269_MOESM1_ESM.mp4

Supplementary material 1 Video 1: A 73-year-old woman was referred for resection of a 25-mm adenoma no lift in the descending part of the duodenum. After circular marking of the lesion with argon plasma coagulation, the EFTR was performed using duodenal full-thickness resection device. (MP4 95,501 kb)

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Andrisani, G., Di Matteo, F.M. Endoscopic full-thickness resection of duodenal lesions (with video). Surg Endosc 34, 1876–1881 (2020). https://doi.org/10.1007/s00464-019-07269-w

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