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 language | English (US) |
|---|---|
| Pages (from-to) | 1-11 |
| Number of pages | 11 |
| Journal | Surgical Endoscopy and Other Interventional Techniques |
| DOIs | |
| State | Accepted/In press - Feb 1 2018 |
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Keywords
- Endoscopic resection
- Nonampullary duodenal neoplasms
- Surgical resection
ASJC Scopus subject areas
- Surgery
Cite this
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 journal › Article
}
TY - JOUR
T1 - Endoscopic and surgical management of nonampullary duodenal neoplasms
AU - Bartel, Michael J.
AU - Puri, Ruchir
AU - Brahmbhatt, Bhaumik
AU - Chen, Wei Chung
AU - Kim, Daniel
AU - Linares, Roberto C.Simons
AU - Stauffer, John A.
AU - Buchanan, Mauricia A.
AU - Bowers, Steven P.
AU - Woodward, Timothy A.
AU - Wallace, Michael B.
AU - Raimondo, Massimo
AU - Asbun, Horacio J.
PY - 2018/2/1
Y1 - 2018/2/1
N2 - 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.
AB - 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.
KW - Endoscopic resection
KW - Nonampullary duodenal neoplasms
KW - Surgical resection
UR - http://www.scopus.com/inward/record.url?scp=85045038062&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85045038062&partnerID=8YFLogxK
U2 - 10.1007/s00464-017-5994-y
DO - 10.1007/s00464-017-5994-y
M3 - Article
C2 - 29392469
AN - SCOPUS:85045038062
SP - 1
EP - 11
JO - Surgical Endoscopy
JF - Surgical Endoscopy
SN - 0930-2794
ER -