Endoscopic and surgical management of nonampullary duodenal neoplasms

Michael J. Bartel, Ruchir Puri, Bhaumik Brahmbhatt, Wei Chung Chen, Daniel Kim, Roberto C.Simons Linares, John A. Stauffer, Mauricia A. Buchanan, Steven P. Bowers, Timothy A. Woodward, Michael B. Wallace, Massimo Raimondo, Horacio J. Asbun

Research output: Contribution to journalArticle

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Abstract

Background: Sporadic nonampullary duodenal neoplasms (SNADN) can have malignant potential for which endoscopic and surgical resections are offered. We report combined gastroenterologic and surgical experience for treatment of SNADN, including endoscopic mucosal resection (EMR) and pancreas-preserving partial duodenectomy (PPPD). Methods: We retrospectively reviewed 121 consecutive patients, who underwent 30 PPPDs and 91 EMRs for mucosal and submucosal SNADN. Decision to undergo EMR or surgical resection was based on expert endoscopist and surgeon discretion including multidisciplinary tumor board review. Main outcomes were recurrence rate of neoplasia and adverse events requiring hospital admission or prolonged care. EMRs were performed with submucosal lifting followed by snare resection. PPPD included total duodenectomy, supra-ampullary PPPD for neoplasms proximal to the ampulla, and infra-ampullary PPPD for lesions distal to the ampulla. Follow-up data were available for 65% of EMR and 73% of surgical patients. Results: Surgically resected neoplasia was larger with more advanced neoplasia and submucosal lesions. En bloc resection was achieved in all surgical resections and in 53% of EMRs. Post-EMR, mucosal and submucosal neoplasia recurred in 32 and 0%, respectively, including five neoplasms (26%) after an initial negative esophagogastroduodenoscopy. All recurrences were treated endoscopically. Complications occurred in 14 endoscopically and eight surgically treated patients, none requiring surgical intervention. Conclusions: Post-EMR patients had higher recurrence of mucosal neoplasia, whereas submucosal neoplasms, mainly carcinoid, did not recur. Polyp size and positive resection margin were not associated with neoplasia recurrence. Patients with SNADN could benefit from a multidisciplinary approach to stratify the optimal treatment based on local expertise.

Original languageEnglish (US)
Pages (from-to)1-11
Number of pages11
JournalSurgical Endoscopy and Other Interventional Techniques
DOIs
StateAccepted/In press - Feb 1 2018

Fingerprint

Duodenal Neoplasms
Neoplasms
Pancreas
Recurrence
Digestive System Endoscopy
Carcinoid Tumor
Polyps

Keywords

  • Endoscopic resection
  • Nonampullary duodenal neoplasms
  • Surgical resection

ASJC Scopus subject areas

  • Surgery

Cite this

Bartel, M. J., Puri, R., Brahmbhatt, B., Chen, W. C., Kim, D., Linares, R. C. S., ... Asbun, H. J. (Accepted/In press). Endoscopic and surgical management of nonampullary duodenal neoplasms. Surgical Endoscopy and Other Interventional Techniques, 1-11. https://doi.org/10.1007/s00464-017-5994-y

Endoscopic and surgical management of nonampullary duodenal neoplasms. / Bartel, Michael J.; Puri, Ruchir; Brahmbhatt, Bhaumik; Chen, Wei Chung; Kim, Daniel; Linares, Roberto C.Simons; Stauffer, John A.; Buchanan, Mauricia A.; Bowers, Steven P.; Woodward, Timothy A.; Wallace, Michael B.; Raimondo, Massimo; Asbun, Horacio J.

In: Surgical Endoscopy and Other Interventional Techniques, 01.02.2018, p. 1-11.

Research output: Contribution to journalArticle

Bartel, MJ, Puri, R, Brahmbhatt, B, Chen, WC, Kim, D, Linares, RCS, Stauffer, JA, Buchanan, MA, Bowers, SP, Woodward, TA, Wallace, MB, Raimondo, M & Asbun, HJ 2018, 'Endoscopic and surgical management of nonampullary duodenal neoplasms', Surgical Endoscopy and Other Interventional Techniques, pp. 1-11. https://doi.org/10.1007/s00464-017-5994-y
Bartel, Michael J. ; Puri, Ruchir ; Brahmbhatt, Bhaumik ; Chen, Wei Chung ; Kim, Daniel ; Linares, Roberto C.Simons ; Stauffer, John A. ; Buchanan, Mauricia A. ; Bowers, Steven P. ; Woodward, Timothy A. ; Wallace, Michael B. ; Raimondo, Massimo ; Asbun, Horacio J. / Endoscopic and surgical management of nonampullary duodenal neoplasms. In: Surgical Endoscopy and Other Interventional Techniques. 2018 ; pp. 1-11.
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abstract = "Background: Sporadic nonampullary duodenal neoplasms (SNADN) can have malignant potential for which endoscopic and surgical resections are offered. We report combined gastroenterologic and surgical experience for treatment of SNADN, including endoscopic mucosal resection (EMR) and pancreas-preserving partial duodenectomy (PPPD). Methods: We retrospectively reviewed 121 consecutive patients, who underwent 30 PPPDs and 91 EMRs for mucosal and submucosal SNADN. Decision to undergo EMR or surgical resection was based on expert endoscopist and surgeon discretion including multidisciplinary tumor board review. Main outcomes were recurrence rate of neoplasia and adverse events requiring hospital admission or prolonged care. EMRs were performed with submucosal lifting followed by snare resection. PPPD included total duodenectomy, supra-ampullary PPPD for neoplasms proximal to the ampulla, and infra-ampullary PPPD for lesions distal to the ampulla. Follow-up data were available for 65{\%} of EMR and 73{\%} of surgical patients. Results: Surgically resected neoplasia was larger with more advanced neoplasia and submucosal lesions. En bloc resection was achieved in all surgical resections and in 53{\%} of EMRs. Post-EMR, mucosal and submucosal neoplasia recurred in 32 and 0{\%}, respectively, including five neoplasms (26{\%}) after an initial negative esophagogastroduodenoscopy. All recurrences were treated endoscopically. Complications occurred in 14 endoscopically and eight surgically treated patients, none requiring surgical intervention. Conclusions: Post-EMR patients had higher recurrence of mucosal neoplasia, whereas submucosal neoplasms, mainly carcinoid, did not recur. Polyp size and positive resection margin were not associated with neoplasia recurrence. Patients with SNADN could benefit from a multidisciplinary approach to stratify the optimal treatment based on local expertise.",
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AU - Kim, Daniel

AU - Linares, Roberto C.Simons

AU - Stauffer, John A.

AU - Buchanan, Mauricia A.

AU - Bowers, Steven P.

AU - Woodward, Timothy A.

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