Approach to the endoscopic resection of duodenal lesions.
Duodenal polyps or lesions are uncommonly found on upper endoscopy. Duodenal lesions can be categorized as subepithelial or mucosally-based, and the type of lesion often dictates the work-up and possible therapeutic options. Subepithelial lesions that can arise in the duodenum include lipomas, gastrointestinal stromal tumors, and carcinoids. Endoscopic ultrasonography with fine needle aspiration is useful in the characterization and diagnosis of subepithelial lesions. Duodenal gastrointestinal stromal tumors and large or multifocal carcinoids are best managed by surgical resection. Brunner's gland tumors, solitary Peutz-Jeghers polyps, and non-ampullary and ampullary adenomas are mucosally-based duodenal lesions, which can require removal and are typically amenable to endoscopic resection. Several anatomic characteristics of the duodenum make endoscopic resection of duodenal lesions challenging. However, advanced endoscopic techniques exist that enable the resection of large mucosally-based duodenal lesions. Endoscopic papillectomy is not without risk, but this procedure can effectively resect ampullary adenomas and allows patients to avoid surgery, which typically involves pancreaticoduodenectomy. Endoscopic mucosal resection and its variations (such as cap-assisted, cap-band-assisted, and underwater techniques) enable the safe and effective resection of most duodenal adenomas. Endoscopic submucosal dissection is possible but very difficult to safely perform in the duodenum.
['Gaspar|Jonathan P|JP|', 'Stelow|Edward B|EB|', 'Wang|Andrew Y|AY|']
D018256:Adenomatous Polyps D014670:Ampulla of Vater D001706:Biopsy D002760:Cholangiopancreatography, Endoscopic Retrograde D004379:Duodenal Neoplasms D020698:Duodenoscopes D004384:Duodenoscopy D019160:Endosonography D004867:Equipment Design D005260:Female D006801:Humans D007413:Intestinal Mucosa D007417:Intestinal Polyps D008297:Male D008875:Middle Aged D011183:Postoperative Complications D016717:Sphincterotomy, Endoscopic D016896:Treatment Outcome
Lesion Polyp Subepithelial Duodenum Adenoma Papillectomy Endoscopic mucosal resection Underwater Endoscopic submucosal dissection Ampulla