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ADENOCARCINOMA OF DUODENUM: SURGICAL OR ENDOSCOPIC TREATMENT?

Alberto Montori, Prof Emeritus. University of Roma Sapienza

INTRODUCTION: IT IS WELL KNOWN THAT THE ADENOCARCINOMA OF THE DUODENUM (ADC) IS A QUITE RARE LESION  INFACT REPRESENTS 40% OF CANCER OF THE SMALL BOWEL AND 30% OF THESE ARE LOCALIZED IN THE PERI-AMPULLARY AREA: 7% AFFECT THE SUB-PAPILLARY TRACT AND ONLY 3% THE SUPRA-PAPILLARY SEGMENT OF THE DUODENUM. THE ADC MAY ARISE FROM DUODENAL POLYPS (FAMILIAL POLYPOSIS, OR GARDNER’S SYNDROM OR BE ASSOCIATED WITH COELIAC DISEASE).

UNTIL NOW THE TREATMENT WAS THE PANCREATODUODENECTOMY (FOR ANATOMO-SURGICAL REASONS AND FOR THE POSSIBILITY OF  REGIONAL LYMPHONODE RESECTION).

INFACT IN MY SERIES OF 476 OF SUCH PROCEDURES, 102 WHERE PERFORMED FOR DUODENAL CANCER.

IN THIS LAST 4 YEARS 18 PATIENTS WITH  ADC OF SUPRA – PAPILLARY SEGMENT OF THE DUODENUM UNDERWENT ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD).

THE PURPOSE OF THIS STUDY WERE TO CHECK THE FEASIBILITY OF THE ESD IN TREATING SUCH CASES.

IN OUR EXPERIENCE THIS KIND OF ENDOSCOPIC OPERATION WAS FEASIBLE WITH HIGH COMPLICATION RATE; PERFORATION IN 3 CASES  (0.54%); AND BLEEDING OCCURRED IN 1 CASE ( 0,18 %). ALL THE COMPLICATIONS WERE SUCCESSFULLY TREATED ENDOSCOPICALLY AND THE LONG – TERM OUTCOMES  WAS FAVORABLE.

CONSITERING THE HIGH RATE OF COMPLICATIONS, THE DIFFICULT AND LONG PROCEDURE, THE COMPLIANCE OF PATIENTS (C02), THE GENERAL ANESTHESIA,  A VERY VERY SKILLED ENDOSCOPIST IS NEEDED.

CONCLUSIONS: THE ESD REPRESENT A NEW ENDOSCOPIC APPROACH ENSTABLISHED IN CLINICAL PRACTICE: END IS PERFORMED FOLLOWING THE INTRALUMINAL PATH (3rd SPACE) WICH,  UNLIKE THE OTHERS, REMAIN VIRTUAL AND HAS TO BE CREATED BY DISSECTING AND EXPANDING THE TISSUES LAYER BETWEEN THE MUCOSA AND THE MUSCOLARIS PROPRIA ALLOWING THE ENDOSCOPE TO GAIN ACCESS. THE BENEFIT OF ESD FOR TREATING THE ADC OF THE SUPRA – PAPILLARY SEGMENT OF THE DUODENUM, ACCORDING TO OUR EXPERIENCE, MUST BE VALIDATE IN THE FUTURE; A PRE – OPERATIVE PET-TAC SCAN EXAMINATION  MUST BE PERFORMED IN ORDER TO DEMOSTRED THE LESION OF THE DUODENUM  AND IF THERE IS ANY LIMPHATIC INVOLVEMENT AND NO INFILTRATION OF THE HEAD OF THE PANCREAS.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 86644

Program Number: P436

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

35

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