ENDOSCOPIC DIAGNOSIS AND TREATMENT OF DUODENAL NEOPLASM

Abstract

Duodenal adenomas are observed as whitish, flat elevated lesions. The features of mucosal carcinoma are redness, large size, irregular surface, and obscure mucosal pattern on magnifying narrow-band imaging (NBI). It is difficult to make a differential diagnosis between adenoma and carcinoma, and the accuracy of endoscopy or biopsy is reported to be 68-78％. Biopsy may induce submucosal fibrosis, which could hamper subsequent endoscopic resection. Duodenal endoscopic submucosal dissection (ESD) has a high complete resection rate, but is associated with a high risk for perforation. There is a high risk for post-operative adverse events among patients with a duodenal mucosal defect due to exposure to bile and pancreatic juice. It is desirable to perform prophylactic clip closure after duodenal ESD.