Secondary Logo

Journal Logo

VIDEO: ENDOSCOPY

Endoscopic Full-Thickness Resection in a Patient With Early Duodenal Cancer

Kiryukhin, Andrey P. MD, PhD1; Pavlov, Pavel MD, PhD1; Tertychnyy, Alexander MD, PhD2; Lapina, Tatyana MD, PhD3; Fedorenko, Alexander MD1

Author Information
doi: 10.14309/crj.0000000000000474
  • Open
  • SDC
  • Associated Video

CASE REPORT

A 45-year-old man was admitted to the hospital for a regular health screening. The patient did not report any significant family medical history or symptoms, such as weight loss, appetite loss, abdominal pain, melena, jaundice, and fever. Physical and laboratory findings (including colonoscopy) were unremarkable. Initial upper gastrointestinal endoscopy revealed a red flat nonampullary lesion (≈0.6 cm) that was elevated with a slightly depressed area (0-IIa + c type) and located on the third part of the duodenum (Figure 1).

Figure 1.
Figure 1.:
(A) Upper gastrointestinal endoscopy before endoscopic full-thickness resection demonstrated a lesion that was elevated with a slightly depressed area in (A) the white-light imaging mode and (B) the narrow-band imaging mode.

A biopsy was performed simultaneously. Biopsy specimens demonstrated areas of densely packed hyperchromic glands with an irregular shape, covered by the epithelium with elongated and rounded nuclei (Figure 2). Thus, the specimen was identified as tubulovillous adenoma with high-grade dysplasia (focuses carcinoma in situ). Video capsule endoscopy of the small bowel (jejunum and ileum) showed no warning signs. At the next stage, the patient underwent the second endoscopic evaluation under propofol sedation for endoscopic full-thickness resection of the lesion with a full-thickness resection device (FTRD; Ovesco Endoscopy, Tubingen, Germany) by using a 1-step clip-and-snare technique.

Figure 2.
Figure 2.:
(A and B) Areas of densely packed hyperchromic glands with irregular shape, covered by the epithelium with elongated and rounded nuclei (hematoxylin and eosin stain).

The procedure was performed under sedation, and the lateral margins were marked with coagulation. The FTRD was mounted on the colonoscope. To prevent mucosal damage and facilitate introduction, balloon dilatation (20 mm) of the upper esophageal sphincter and the pylorus was tentatively performed. The lesion was pulled into the cap by tissue anchor after the over-the-scope clip was deployed and created a full-thickness duplication of the duodenum wall (Figure 1). The resection field was inspected to confirm the absence of perforation and bleeding (Video 1; watch the video at http://links.lww.com/ACGCR/A25). The histology confirmed complete (R0) full-thickness resection with no complications during the postoperative period. The patient was discharged on postoperative day 3. We electronically searched the PubMed database (January 2000–March 2020). There were a total of 46 results appeared for the keywords “duodenal full-thickness resection” and 4 for “duodenal FTRD.”

DISCLOSURES

Author contributions: AP Kiryukhin wrote the manuscript, approved the final manuscript, and is the article guarantor. P. Pavlov edited the manuscript, revised the manuscript for intellectual content, and approved the final manuscript. A. Tertychnyy, T. Lapina, and A. Fedorenko helped interpreted the data.

Financial disclosure: None to report.

Informed consent was obtained for this case report.

Supplemental Digital Content

© 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.