Endoscopic submucosal dissection in the management of bleeding duodenal tumors refractory to conventional therapy

Q3 Medicine
Daryl Ramai MD, MPH, MSc, Abdulrahman Qatomah MBBS, Marvin Ryou MD, Christopher C. Thompson MD, Hiroyuki Aihara MD, PhD
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引用次数: 0

Abstract

Background and Aims

Although isolated hamartomas are rare, they can cause bleeding that is refractory to medical treatment. Management strategies depend on factors such as tumor location, size, and bleeding intensity.

Methods

A 94-year-old woman experienced melena and a significant decrease in hemoglobin from 13 g/dL to 7 g/dL. An EGD revealed a large, bleeding pedunculated tumor in the duodenum. Previous interventions, including epinephrine injection and EMR, failed, necessitating multiple blood transfusions. After multidisciplinary consultation, endoscopic submucosal dissection was undertaken.

Results

En bloc resection of the duodenal lesion was performed successfully. The specimen was segmented and removed without causing any trauma to the duodenal wall.

Conclusions

Hamartomas in the upper GI tract, particularly in the stomach or duodenum, pose a greater bleeding risk. Endoscopic submucosal dissection effectively removes large duodenal tumors, especially when EMR is unfeasible. Segmenting the specimen during retrieval minimizes trauma to surrounding tissue, preserving duodenal integrity.
内镜下粘膜夹层在治疗常规治疗难治性十二指肠出血肿瘤中的应用
背景和目的虽然孤立的错构瘤是罕见的,但它们可引起出血,难以药物治疗。治疗策略取决于诸如肿瘤位置、大小和出血强度等因素。方法一名94岁女性出现黑黑,血红蛋白从13 g/dL显著下降到7 g/dL。EGD显示十二指肠有一个大的出血带蒂肿瘤。以前的干预措施,包括肾上腺素注射和电子病历,都失败了,需要多次输血。经多学科会诊,内镜下粘膜夹层进行。结果成功切除了十二指肠病变。标本被分割并移除,没有对十二指肠壁造成任何创伤。结论上消化道肿瘤,尤其是胃、十二指肠肿瘤出血风险较大。内镜下粘膜下剥离术能有效切除大的十二指肠肿瘤,尤其是在EMR不可行的情况下。在取出标本时对标本进行分割,最大限度地减少对周围组织的创伤,保持十二指肠的完整性。
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来源期刊
VideoGIE
VideoGIE Medicine-Gastroenterology
CiteScore
1.50
自引率
0.00%
发文量
132
审稿时长
105 days
期刊介绍: VideoGIE, an official video journal of the American Society for Gastrointestinal Endoscopy, is an Open Access, online-only journal to serve patients with digestive diseases. VideoGIE publishes original, single-blinded peer-reviewed video case reports and case series of endoscopic procedures used in the study, diagnosis, and treatment of digestive diseases. Videos demonstrate use of endoscopic systems, devices, and techniques; report outcomes of endoscopic interventions; and educate physicians and patients about gastrointestinal endoscopy. VideoGIE serves the educational needs of endoscopists in training as well as advanced endoscopists, endoscopy staff and industry, and patients. VideoGIE brings video commentaries from experts, legends, committees, and leadership of the society. Careful adherence to submission guidelines will avoid unnecessary delays, as incomplete submissions may be returned to the authors before initiation of the peer review process.
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