World Endoscopy Organization Position Statements for the Role of Endoscopy on the Diagnosis and Treatment of Superficial Non-Ampullary Duodenal Epithelial Tumors

Abstract

The implementation of screening endoscopy and the increasing availability of image-enhanced endoscopy (IEE) has significantly improved the detection of superficial non-ampullary duodenal epithelial tumors (SNADETs). At the same time, growing experience with advanced endoscopic resection (ER) techniques throughout the gastrointestinal (GI) tract has recently extended to the duodenum—an organ traditionally regarded with caution by endoscopists due to its substantial risk of major treatment related complications. These advances have made it possible to achieve successful endoscopic managements of duodenal superficial neoplasms, allowing organ-preservation and reducing the need for highly invasive surgical procedures. Despite this progress, a comprehensive global statement dedicated specifically to the diagnosis and management of duodenal neoplasms has been lacking. Current approaches remain heterogeneous, with substantial geographic variability. To address this gap, we developed an international position statement to guide the diagnosis and management of SNADETs. Nine position statements were formulated regarding the role of endoscopy in diagnosing SNADETs, highlighting the importance of a routine inspection of the first and second part of the duodenum, the role of high-definition endoscopy in the identification of SNADETs, and the increasing role of IEE in the characterization of duodenal neoplasms. In addition, seven statements were developed emphasizing that ER is the preferred approach to manage SNADETs, but it carries a substantial risk of complications, thus complete wound closure after ER should be routinely adopted. A thorough understanding of the current endoscopic strategies and advances to address duodenal neoplastic lesions will ensure a safe, minimally invasive, and effective management of SNADETs globally.