Surgical Endoscopy

, Volume 32, Issue 6, pp 2859–2869 | Cite as

Endoscopic and surgical management of nonampullary duodenal neoplasms

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

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.

Keywords

Nonampullary duodenal neoplasms Endoscopic resection Surgical resection 

Abbreviations

APC

Argon plasma coagulation

ASA

American Society of Anesthesiologists

EGD

Esophagogastroduodenoscopy

EMR

Endoscopic mucosal resection

ESD

Endoscopic submucosal dissection

EUS

Endoscopic ultrasound

PPD

Pancreas-preserving duodenectomy

PPPD

Pancreas-preserving partial duodenectomy

PPTD

Pancreas-preserving total duodenectomy

SNADN

Sporadic nonampullary duodenal neoplasms

Notes

Author contributions

MJB and RP contributed to the collection, analysis, and interpretation of data; drafting and critical revision of the article; and generation of the figures. BB, WCC, DK, and CRSL contributed to the collection of data and critical revision of the article. MAB contributed to the analysis and interpretation of data and critical revision of the article. JAS, SPB, TAW, MBW, MR, and AJH contributed to the conception and design, experiments, and critical revision of the article. All authors approved the final draft of the article.

Compliance with ethical standards

Disclosures

Dr. Wallace has research grants from Olympus, NinePoint, Boston Scientific, Cosmo Pharmaceuticals, and equity in iLumen. None of these disclosures were relevant for any part of this manuscript. Drs. 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, Massimo Raimondo, and Horacio J. Asbun have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018
Corrected publication February/2018

Authors and Affiliations

  • Michael J. Bartel
    • 1
    • 2
  • Ruchir Puri
    • 3
  • Bhaumik Brahmbhatt
    • 1
  • Wei-Chung Chen
    • 1
  • Daniel Kim
    • 4
  • Carlos Roberto Simons-Linares
    • 1
  • John A. Stauffer
    • 4
  • Mauricia A. Buchanan
    • 3
  • Steven P. Bowers
    • 4
  • Timothy A. Woodward
    • 1
  • Michael B. Wallace
    • 1
  • Massimo Raimondo
    • 1
  • Horacio J. Asbun
    • 4
  1. 1.Department of GastroenterologyMayo ClinicJacksonvilleUSA
  2. 2.Section of GastroenterologyFox Chase Cancer CenterPhiladelphiaUSA
  3. 3.Department of SurgeryUniversity of FloridaJacksonvilleUSA
  4. 4.Department of SurgeryMayo ClinicJacksonvilleUSA

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