A prospective study of duodenal laparoscopy-endoscopy cooperative surgery for superficial duodenal tumors, including periampullary and medial wall lesions.

IF 3.8 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease Pub Date : 2025-09-13 DOI:10.1016/j.dld.2025.08.087

Takaya Shimura, Naomi Sugimura, Mika Kitagawa, Makiko Sasaki, Shigeki Fukusada, Shinnosuke Harata, Tomotaka Okubo, Hiroyuki Sagawa, Shuji Takiguchi, Hiromi Kataoka

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引用次数: 0

Abstract

Background: Duodenal laparoscopy-endoscopy cooperative surgery (D-LECS) is a novel technique involving duodenal endoscopic submucosal dissection (ESD) followed by laparoscopic seromuscular suturing. However, D-LECS has not been standardized due to limited data.

Methods: This single-center prospective study enrolled 20 patients with superficial nonampullary duodenal tumors (SNADETs) located in the descending or transverse part from August 2019 to December 2023. The primary endpoint was the clinical success rate of d-LECS, defined as the completion of scheduled D-LECS with complete resection and closure of the post-ESD ulcer. ESD was performed by the single endoscopist.

Results: The median tumor size was 30 mm, with a median treatment time of 296 min for total D-LECS and 115 min for ESD. The clinical success rate was 100 %, with 100 % en bloc resection, 80 % R0 resection, and no recurrence. Eight lesions were located in the medial wall, including five periampullary tumors, all of which achieved complete closure of post-ESD ulcers by combining endoscopic clipping with laparoscopic suturing. Intraoperative perforation occurred in three cases but was immediately repaired with laparoscopic suturing. No postoperative perforations or bleeding were observed.

Conclusion: D-LECS is a minimally invasive and safe treatment for SNADTs, allowing for en bloc resection with a low risk of recurrence.

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十二指肠内镜-腹腔镜联合手术治疗十二指肠浅表性肿瘤，包括壶腹周围及内侧壁病变的前瞻性研究。

背景：十二指肠腹腔镜-内窥镜联合手术（D-LECS）是一项涉及十二指肠内镜下粘膜剥离（ESD）后腹腔镜血清肌缝合的新技术。然而，由于数据有限，D-LECS尚未标准化。方法：这项单中心前瞻性研究于2019年8月至2023年12月招募了20例位于下行或横向部分的浅表性非盆腹十二指肠肿瘤（SNADETs）。主要终点是d-LECS的临床成功率，定义为完成预定的d-LECS，并完全切除和闭合esd后溃疡。ESD由单内窥镜医师完成。结果：中位肿瘤大小为30 mm，总D-LECS的中位治疗时间为296 min， ESD的中位治疗时间为115 min。临床成功率为100%，整体切除100%，R0切除80%，无复发。8个病变位于内侧壁，包括5个壶腹周围肿瘤，均通过内镜夹持与腹腔镜缝合相结合实现了esd后溃疡的完全闭合。术中出现穿孔3例，均立即行腹腔镜缝合修复。术后未见穿孔或出血。结论：D-LECS是一种微创、安全的snadt治疗方法，可实现整体切除，复发风险低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Digestive and Liver Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

2.20%

发文量

632

审稿时长

19 days

期刊介绍： Digestive and Liver Disease is an international journal of Gastroenterology and Hepatology. It is the official journal of Italian Association for the Study of the Liver (AISF); Italian Association for the Study of the Pancreas (AISP); Italian Association for Digestive Endoscopy (SIED); Italian Association for Hospital Gastroenterologists and Digestive Endoscopists (AIGO); Italian Society of Gastroenterology (SIGE); Italian Society of Pediatric Gastroenterology and Hepatology (SIGENP) and Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Digestive and Liver Disease publishes papers on basic and clinical research in the field of gastroenterology and hepatology. Contributions consist of: Original Papers Correspondence to the Editor Editorials, Reviews and Special Articles Progress Reports Image of the Month Congress Proceedings Symposia and Mini-symposia.