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水下内镜下黏膜切除术治疗十二指肠降部平坦型息肉1例并文献复习
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Abstract:
目的：探讨水下内镜下黏膜切除术(UEMR)治疗十二指肠平坦型病变的效果。方法：回顾性分析青岛大学附属医院消化内科收治的1例十二指肠降部平坦型息肉病例的临床、内镜特点及其内镜治疗结果。结果：60岁女性因常规查体行胃镜检查，白光内镜十二指肠降部见约10 × 8 mm低平隆起，NBI结合放大胃镜显示病变边界清晰，微血管及微结构欠规则。行UEMR完整切除病变，术后病理为管状腺瘤，无并发症发生。结论：UEMR操作简单，完整切除率高，术后并发症少，复发率低，可作为内镜下切除十二指肠平坦型病变简单、安全、有效的方法进行临床推广。
Objective: To evaluate the therapeutic efficacy of underwater endoscopic mucosal resection (UEMR) in the management of duodenal flat lesions. Methods: We present a case study involving a patient with a flat polyp in the descending duodenum who was admitted to the Gastroenterology Department of the Affiliated Hospital of Qingdao University. A retrospective analysis was conducted to examine the patient’s clinical presentation, endoscopic characteristics, and outcomes following endoscopic treatment. Results: A 60-year-old woman underwent gastroscopy due to routine checkup, and about 10 × 8 mm low flat bulge was seen in the descending part of duodenum under white light endoscopy, and NBI combined with magnified gastroscopy showed that the lesion had clear boundaries, and microvessels and microstructures were under-regularized. UEMR was performed for complete resection of the lesion, and the postoperative pathology was tubular adenoma without complications. Conclusion: UEMR is simple to operate, with a high rate of complete resection, few postoperative complications, and a low recurrence rate, and can be clinically promoted as a simple, safe, and effective method for endoscopic resection of duodenal flat lesions.
| [1] | 高福利, 邹晓平. 内镜下治疗十二指肠早癌的疗效分析[J]. 胃肠病学和肝病学杂志, 2022, 31(10): 1148-1151. |
| [2] | Burgess, N.G., Bahin, F.F. and Bourke, M.J. (2015) Colonic Polypectomy (with Videos). Gastrointestinal Endoscopy, 81, 813-835. https://doi.org/10.1016/j.gie.2014.12.027 |
| [3] | Binmoeller, K.F., Weilert, F., Shah, J., Bhat, Y. and Kane, S. (2012) “Underwater” EMR without Submucosal Injection for Large Sessile Colorectal Polyps (with Video). Gastrointestinal Endoscopy, 75, 1086-1091. https://doi.org/10.1016/j.gie.2011.12.022 |
| [4] | 王佳淇, 邵晓娜, 沈建伟. 非壶腹部十二指肠浅表肿瘤内镜微创治疗的进展[J]. 新医学, 2023, 54(5): 317-320. |
| [5] | Akahoshi, K., Kubokawa, M., Inamura, K., Akahoshi, K., Shiratsuchi, Y. and Tamura, S. (2020) Current Challenge: Endoscopic Submucosal Dissection of Superficial Non-Ampullary Duodenal Epithelial Tumors. Current Treatment Options in Oncology, 21, Article No. 98. https://doi.org/10.1007/s11864-020-00796-y |
| [6] | Ma, M.X. and Bourke, M.J. (2017) Management of Duodenal Polyps. Best Practice & Research Clinical Gastroenterology, 31, 389-399. https://doi.org/10.1016/j.bpg.2017.04.015 |
| [7] | Farnell, M.B., Sakorafas, G.H., Sarr, M.G., Rowland, C.M., Tsiotos, G.G., Farley, D.R., et al. (2000) Villous Tumors of the Duodenum: Reappraisal of Local vs. Extended Resection. Journal of Gastrointestinal Surgery, 4, 13-23. https://doi.org/10.1016/s1091-255x(00)80028-1 |
| [8] | Alexander, S., Bourke, M.J., Williams, S.J., Bailey, A. and Co, J. (2009) EMR of Large, Sessile, Sporadic Nonampullary Duodenal Adenomas: Technical Aspects and Long-Term Outcome (with Videos). Gastrointestinal Endoscopy, 69, 66-73. https://doi.org/10.1016/j.gie.2008.04.061 |
| [9] | Longacre, T.A. and Fenoglio-Preiser, C.M. (1990) Mixed Hyperplastic Adenomatous Polyps/Serrated Adenomas. The American Journal of Surgical Pathology, 14, 524-537. https://doi.org/10.1097/00000478-199006000-00003 |
| [10] | Soetikno, R.M., Gotoda, T., Nakanishi, Y. and Soehendra, N. (2003) Endoscopic Mucosal Resection. Gastrointestinal Endoscopy, 57, 567-579. https://doi.org/10.1067/mge.2003.130 |
| [11] | Marques, J., Baldaque-Silva, F., Pereira, P., Arnelo, U., Yahagi, N. and Macedo, G. (2015) Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection in the Treatment of Sporadic Nonampullary Duodenal Adenomatous Polyps. World Journal of Gastrointestinal Endoscopy, 7, 720-727. https://doi.org/10.4253/wjge.v7.i7.720 |
| [12] | Bourke, M. (2013) Endoscopic Resection in the Duodenum: Current Limitations and Future Directions. Endoscopy, 45, 127-132. https://doi.org/10.1055/s-0032-1326177 |
| [13] | Lépilliez, V., Chemaly, M., Ponchon, T., Napoleon, B. and Saurin, J. (2008) Endoscopic Resection of Sporadic Duodenal Adenomas: An Efficient Technique with a Substantial Risk of Delayed Bleeding. Endoscopy, 40, 806-810. https://doi.org/10.1055/s-2008-1077619 |
| [14] | Min, Y.W., Min, B., Kim, E.R., Lee, J.H., Rhee, P., Rhee, J.C., et al. (2013) Efficacy and Safety of Endoscopic Treatment for Nonampullary Sporadic Duodenal Adenomas. Digestive Diseases and Sciences, 58, 2926-2932. https://doi.org/10.1007/s10620-013-2708-8 |
| [15] | Fanning, S.B., Bourke, M.J., Williams, S.J., Chung, A. and Kariyawasam, V.C. (2012) Giant Laterally Spreading Tumors of the Duodenum: Endoscopic Resection Outcomes, Limitations, and Caveats. Gastrointestinal Endoscopy, 75, 805-812. https://doi.org/10.1016/j.gie.2011.11.038 |
| [16] | Basford, P.J., George, R., Nixon, E., Chaudhuri, T., Mead, R. and Bhandari, P. (2014) Endoscopic Resection of Sporadic Duodenal Adenomas: Comparison of Endoscopic Mucosal Resection (EMR) with Hybrid Endoscopic Submucosal Dissection (ESD) Techniques and the Risks of Late Delayed Bleeding. Surgical Endoscopy, 28, 1594-1600. https://doi.org/10.1007/s00464-013-3356-y |
| [17] | Klein, A., Ahlenstiel, G., Tate, D., Burgess, N., Richardson, A., Pang, T., et al. (2017) Endoscopic Resection of Large Duodenal and Papillary Lateral Spreading Lesions Is Clinically and Economically Advantageous Compared with Surgery. Endoscopy, 49, 659-667. https://doi.org/10.1055/s-0043-105484 |
| [18] | Tomizawa, Y. and Ginsberg, G.G. (2018) Clinical Outcome of EMR of Sporadic, Nonampullary, Duodenal Adenomas: A 10-Year Retrospective. Gastrointestinal Endoscopy, 87, 1270-1278. https://doi.org/10.1016/j.gie.2017.12.026 |
| [19] | Valerii, G., Tringali, A., Landi, R., Boškoski, I., Familiari, P., Bizzotto, A., et al. (2018) Endoscopic Mucosal Resection of Non-Ampullary Sporadic Duodenal Adenomas: A Retrospective Analysis with Long-Term Follow-Up. Scandinavian Journal of Gastroenterology, 53, 490-494. https://doi.org/10.1080/00365521.2018.1438508 |
| [20] | Kim, H.G., Thosani, N., Banerjee, S., Chen, A. and Friedland, S. (2014) Underwater Endoscopic Mucosal Resection for Recurrences after Previous Piecemeal Resection of Colorectal Polyps (with Video). Gastrointestinal Endoscopy, 80, 1094-1102. https://doi.org/10.1016/j.gie.2014.05.318 |
| [21] | Kato, M., Kanai, T. and Yahagi, N. (2021) Endoscopic Resection of Superficial Non-Ampullary Duodenal Epithelial Tumor. DEN Open, 2, e54. https://doi.org/10.1002/deo2.54 |
| [22] | Nett, A. and Binmoeller, K. (2019) Underwater Endoscopic Mucosal Resection. Gastrointestinal Endoscopy Clinics of North America, 29, 659-673. https://doi.org/10.1016/j.giec.2019.05.004 |
| [23] | Li, Z., Dou, L., Liu, Y., Zhang, Y., He, S., Zhu, J., et al. (2021) The Value of Endoscopic Resection for Non-Ampullary Duodenal Lesions. Saudi Journal of Gastroenterology, 27, 302-308. https://doi.org/10.4103/sjg.sjg_646_20 |
| [24] | Hoteya, S., Yahagi, N., Iizuka, T., Kikuchi, D., Mitani, T., Matsui, A., et al. (2013) Endoscopic Submucosal Dissection for Nonampullary Large Superficial Adenocarcinoma/adenoma of the Duodenum: Feasibility and Long-Term Outcomes. Endoscopy International Open, 1, 2-7. https://doi.org/10.1055/s-0033-1359232 |
| [25] | Cammarota, G., Cesaro, P., Cazzato, A., Cianci, R., Fedeli, P., Ojetti, V., et al. (2009) The Water Immersion Technique Is Easy to Learn for Routine Use during EGD for Duodenal Villous Evaluation. Journal of Clinical Gastroenterology, 43, 244-248. https://doi.org/10.1097/mcg.0b013e318159c654 |
| [26] | Wang, A.Y., Flynn, M.M., Patrie, J.T., Cox, D.G., Bleibel, W., Mann, J.A., et al. (2013) Underwater Endoscopic Mucosal Resection of Colorectal Neoplasia Is Easily Learned, Efficacious, and Safe. Surgical Endoscopy, 28, 1348-1354. https://doi.org/10.1007/s00464-013-3297-5 |
| [27] | Spadaccini, M., Fuccio, L., Lamonaca, L., Frazzoni, L., Maselli, R., Di Leo, M., et al. (2019) Underwater EMR for Colorectal Lesions: A Systematic Review with Meta-Analysis (with Video). Gastrointestinal Endoscopy, 89, 1109-1116.e4. https://doi.org/10.1016/j.gie.2018.10.023 |
| [28] | Chowdhury, A.R., Kim, J.S., Xu, M., Tom, C., Narala, R., Kong, N., et al. (2023) Underwater versus Conventional Endoscopic Mucosal Resection for Colorectal Lesions: An Updated Meta-Analysis of Randomized Controlled Trials. Endoscopy International Open, 11, E935-E942. https://doi.org/10.1055/a-2150-9899 |
| [29] | Bhogal, N. (2020) Efficacy and Safety of Underwater Endoscopic Mucosal Resection for Superficial Non-Ampullary Duodenal Epithelial Tumors: Systematic Review and Meta-Analysis. Annals of Gastroenterology, 33, 1-13. https://doi.org/10.20524/aog.2020.0504 |
| [30] | Liu, J., Duan, S., Wang, Y., Peng, H., Kong, Y. and Yao, S. (2023) Efficacy and Safety of Underwater Endoscopic Mucosal Resection for ≤20 mm Superficial Non-Ampullary Duodenal Epithelial Tumors: Systematic Review and Meta-Analysis. Frontiers in Medicine, 9, Article 1077806. https://doi.org/10.3389/fmed.2022.1077806 |
| [31] | 吴小超, 吴沛瑶, 黄晓丹, 等. 内镜下治疗十二指肠占位性病变的安全性、有效性及临床价值研究[J]. 中国内镜杂志, 2018, 24(1): 5-10. |
