Endoscopic Resection Techniques for Duodenal and Ampullary Adenomas.
Journal
VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy
ISSN: 2468-4481
Titre abrégé: VideoGIE
Pays: United States
ID NLM: 101719677
Informations de publication
Date de publication:
Aug 2023
Aug 2023
Historique:
medline:
14
8
2023
pubmed:
14
8
2023
entrez:
14
8
2023
Statut:
epublish
Résumé
Duodenal polyps have a reported incidence of 0.3% to 4.6%. Sporadic, nonampullary duodenal adenomas (SNDAs) comprise less than 10% of all duodenal polyps, and ampullary adenomas are even less common. Nonetheless, the incidence continues to rise because of widespread endoscopy use. Duodenal polyps with villous features or those that are larger than 10 mm may raise concern for malignancy and require removal. We demonstrate endoscopic resection of SNDAs and ampullary adenomas using some of our preferred techniques. The duodenum has several components that can make EMR of duodenal polyps technically challenging. Not only does the duodenum have a thin muscle layer, but it is also highly mobile and vascular, which may explain higher rates of perforation and bleeding of duodenal EMR reported in the literature compared with colon EMR. A standard adult gastroscope with a distal cap is commonly used for duodenal EMRs. Based on the location, however, side-viewing duodenoscopes or pediatric colonoscopes may be used. To prepare for EMR, a submucosal injection is performed for an adequate lift. The polyp is then resected via stiff monofilament snares and subsequently closed with hemostatic clips if feasible. The ampullectomy technique differs slightly from duodenal EMRs and carries the additional risk of pancreatitis. Submucosal injection in the ampulla may not lift well; thus, its utility is debatable. Biliary sphincterotomy should be performed, and based on endoscopist preference, the pancreatic duct (PD) guidewire can be left during resection to maintain access. After resection, a PD stent is placed to minimize pancreatitis risk. The video shows the aforementioned duodenal EMR techniques. Two clips of ampullectomy are also shown in the video. A few common techniques used to perform duodenal EMR and ampullectomy are highlighted in the video. It is important to understand and manage adverse events associated with these procedures and to have established surveillance plans.
Sections du résumé
Background and Aims
UNASSIGNED
Duodenal polyps have a reported incidence of 0.3% to 4.6%. Sporadic, nonampullary duodenal adenomas (SNDAs) comprise less than 10% of all duodenal polyps, and ampullary adenomas are even less common. Nonetheless, the incidence continues to rise because of widespread endoscopy use. Duodenal polyps with villous features or those that are larger than 10 mm may raise concern for malignancy and require removal. We demonstrate endoscopic resection of SNDAs and ampullary adenomas using some of our preferred techniques.
Methods
UNASSIGNED
The duodenum has several components that can make EMR of duodenal polyps technically challenging. Not only does the duodenum have a thin muscle layer, but it is also highly mobile and vascular, which may explain higher rates of perforation and bleeding of duodenal EMR reported in the literature compared with colon EMR. A standard adult gastroscope with a distal cap is commonly used for duodenal EMRs. Based on the location, however, side-viewing duodenoscopes or pediatric colonoscopes may be used. To prepare for EMR, a submucosal injection is performed for an adequate lift. The polyp is then resected via stiff monofilament snares and subsequently closed with hemostatic clips if feasible. The ampullectomy technique differs slightly from duodenal EMRs and carries the additional risk of pancreatitis. Submucosal injection in the ampulla may not lift well; thus, its utility is debatable. Biliary sphincterotomy should be performed, and based on endoscopist preference, the pancreatic duct (PD) guidewire can be left during resection to maintain access. After resection, a PD stent is placed to minimize pancreatitis risk.
Results
UNASSIGNED
The video shows the aforementioned duodenal EMR techniques. Two clips of ampullectomy are also shown in the video.
Conclusions
UNASSIGNED
A few common techniques used to perform duodenal EMR and ampullectomy are highlighted in the video. It is important to understand and manage adverse events associated with these procedures and to have established surveillance plans.
Identifiants
pubmed: 37575136
doi: 10.1016/j.vgie.2023.05.006
pii: S2468-4481(23)00071-1
pmc: PMC10422085
doi:
Types de publication
Journal Article
Review
Langues
eng
Pagination
330-335Informations de copyright
© 2023 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc.
Références
World J Gastroenterol. 2010 Nov 21;16(43):5474-80
pubmed: 21086567
Gastrointest Endosc. 2015 Nov;82(5):773-81
pubmed: 26260385
Surg Innov. 2004 Dec;11(4):255-63
pubmed: 15756395
Gut Liver. 2014 May;8(3):306-12
pubmed: 24827628
Dtsch Med Wochenschr. 1984 Aug 3;109(31-32):1183-6
pubmed: 6745123
Digestion. 2018;97(1):45-51
pubmed: 29393159
Gastrointest Endosc. 2016 Oct;84(4):688-96
pubmed: 26975231
Endoscopy. 2020 Sep;52(9):773-779
pubmed: 32316041
J Gastroenterol Hepatol. 2014 Dec;29 Suppl 4:77-9
pubmed: 25521738
United European Gastroenterol J. 2021 Oct;9(8):938-946
pubmed: 34355525
ANZ J Surg. 2007 May;77(5):371-3
pubmed: 17497979
Endosc Int Open. 2019 Dec;7(12):E1763-E1767
pubmed: 31828214
Surgery. 2000 Jun;127(6):628-33
pubmed: 10840357
Scand J Gastroenterol. 1994 Jun;29(6):483-7
pubmed: 8079103
Lancet. 1994 Dec 3;344(8936):1582
pubmed: 7983986
Am J Gastroenterol. 2008 Jun;103(6):1505-9
pubmed: 18510617
Surg Endosc. 2022 May;36(5):2954-2961
pubmed: 34129089
J Clin Gastroenterol. 1981 Jun;3(2):139-47
pubmed: 7240690
World J Gastrointest Oncol. 2020 Aug 15;12(8):918-930
pubmed: 32879668
Endosc Int Open. 2016 Apr;4(4):E415-9
pubmed: 27092320
Gastrointest Endosc. 2005 Sep;62(3):367-70
pubmed: 16111953
Dig Dis Sci. 2022 Mar;67(3):971-977
pubmed: 33723697
Gastrointest Endosc. 2013 Sep;78(3):496-502
pubmed: 23642790
Gastrointest Endosc. 2022 Aug;96(2):330-338
pubmed: 35288147
Surgery. 2000 Oct;128(4):694-701
pubmed: 11015104
Gastrointest Endosc. 2022 Jan;95(1):140-148
pubmed: 34284025
Am J Gastroenterol. 2022 Sep 1;117(9):1402
pubmed: 35416796
Dig Endosc. 2014 Apr;26 Suppl 2:23-9
pubmed: 24750144
Ann Surg. 1988 Mar;207(3):234-9
pubmed: 3345110
Shock. 2012 Mar;37(3):297-305
pubmed: 22089198
Dig Liver Dis. 2023 Jun;55(6):714-720
pubmed: 36195547
Endoscopy. 2021 May;53(5):522-534
pubmed: 33822331
Endosc Int Open. 2022 Aug 15;10(8):E1136-E1146
pubmed: 36238531
Endoscopy. 2018 Feb;50(2):154-158
pubmed: 28962044
Cancer. 1981 Aug 1;48(3):799-819
pubmed: 7248908
Scand J Gastroenterol. 2000 Apr;35(4):337-44
pubmed: 10831254
Cancer. 1990 Aug 15;66(4):702-15
pubmed: 2167140
World J Gastrointest Endosc. 2011 Dec 16;3(12):241-7
pubmed: 22195233
Endoscopy. 2021 Jan;53(1):27-35
pubmed: 32679602
Clin Gastroenterol Hepatol. 2019 Jan;17(1):16-25.e1
pubmed: 30077787
Endosc Int Open. 2013 Dec;1(1):2-7
pubmed: 26135505
Neth J Med. 1993 Feb;42(1-2):5-11
pubmed: 8446225
Ann Gastroenterol. 2021;34(2):169-176
pubmed: 33654355
Gastrointest Endosc. 2023 Jun;97(6):1100-1108
pubmed: 36720290
J Gastrointest Surg. 2000 Jan-Feb;4(1):13-21, discussion 22-3
pubmed: 10631358
Gastrointest Endosc. 2016 Oct;84(4):700-8
pubmed: 27063918
Am J Gastroenterol. 2011 Feb;106(2):357-64
pubmed: 21139577
World J Gastroenterol. 2014 Sep 21;20(35):12501-8
pubmed: 25253950
Gastrointest Endosc. 2018 May;87(5):1270-1278
pubmed: 29317270
Gastrointest Endosc. 2004 Sep;60(3):397-9
pubmed: 15332030
Ann Gastroenterol. 2020 Jul-Aug;33(4):379-384
pubmed: 32624658