Abstract
A 72-year-old asymptomatic man was referred to our department for evaluation of a protruding lesion in the anterior wall of the duodenal bulb detected on follow-up upper gastrointestinal endoscopy for gastroesophageal reflux disease. Biopsy revealed serrated adenomatous structures with epithelial changes and nuclear atypia, which led to a diagnosis of Group 3 adenoma. The lesion was not present when the same test had been performed seven years earlier. While taking into consideration the possibility of concurrent primary duodenal carcinoma, we completely resected the lesion via laparoscopy-assisted distal gastrectomy encompassing the lesion, along with lymph node dissection. We opted not to perform local excision due to the risk of inadvertently causing symptoms such as postoperative stenosis and also to avoid additional surgery. The pathologic diagnosis was SM invasion with N0. Our experience suggests that, for duodenal lesions with SM invasion, laparoscopy-assisted distal gastrectomy with lymph node dissection is among the feasible treatment options if preoperative CT scans show no regional lymph node involvement (N0).
