Endoscopic Management of Non-ampullary Duodenal Neoplasia
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.
KeywordsDuodenum Neoplasia Endoscopic mucosal resection Endoscopic submucosal dissection