Endoscopic submucosal dissection using countertraction with clips and rubber band allows safe en bloc resection of recurrent duodenal superficial lesions with intense fibrosis
Year: 2020
Type: article
Study design: Case Report
Abstract: Superficial duodenal epithelial neoplasia ([ Fig. 1 ]) can be endoscopically removed either with cold snare resection, conventional endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). EMR is safe but can lead to a 20 % – 30 % recurrence rate because of piecemeal resections. Conversely, duodenal ESD has a high rate of en bloc resection but is technically challenging and has ≤ 50 % risk of complications (bleeding and perforation) [ 1 ] [ 2 ]. Fig. 1 Duodenal adenomatous polyps. a Narrow-band imaging (NBI). b Dual-focus NBI. We present the case of a 60-year-old patient with multiple sporadic duodenal adenomas. One of the lesions was particularly challenging because it was a recurrence after a previous EMR. Hybrid endoscopic resection was attempted but impossible due to severe submucosal fibrosis. We therefore performed ESD using the clip and rubber band traction technique ([ Video 1 ]) [ 3 ] [ 4 ]. We closed the duodenal scar using clips and the patient was discharged after 48 hours of follow-up. The histology exam showed en bloc resection of a low-grade dysplastic duodenal adenoma and there were no complications after 3 weeks of follow-up. Video 1 Endoscopic submucosal dissection using countertraction for recurrent duodenal superficial lesions. Quality: mobile 360 480 720 Download This is one of the first video cases showing ESD for duodenal recurrent lesions with severe fibrosis. As a full-thickness resection device for resection of upper digestive tract lesions is not yet approved in Europe, ESD using countertraction techniques can be an option for cases with intense fibrosis and high risk of perforation using conventional EMR. Endoscopy_UCTN_Code_TTT_1AO_2AG Endoscopy E-Videos https://eref.thieme.de/e-videos Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online. This section has its own submission website at https://mc.manuscriptcentral.com/e-videos Publication History Article published online: 17 April 2020 © 2020. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
Source: Endoscopy
DOI: 10.1055/a-1144-2611
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W3016482469