Endoscopic Management of Non-ampullary Duodenal Neoplasia

Abstract

A portion of non-ampullary duodenal neoplasia including adenoma, adenocarcinoma, and neuroendocrine tumors are good candidates for endoscopic resection. Endoscopic mucosal resection (EMR) is a technically safe and feasible method for treatment of non-ampullary duodenal neoplasia. However, endoscopic submucosal dissection (ESD) is a technically challenging procedure even in experts of therapeutic endoscopy, and serious complications such as delayed bleeding or perforation may occur frequently. Successful ESD for non-ampullary duodenal neoplasia may be aided by various accessories or advanced skills including small-caliber-tip caps, tunneling techniques, and “push and peel-off technique.” However, more technical advances and clinical experiences are needed to improve the short- and long-term outcomes of ESD for non-ampullary duodenal neoplasia. For successful endoscopic resection, physicians should be familiar with the various instruments needed for the procedure and able to handle them skillfully.