Therapeutic value of endoscopy for primary duodenal lesions

中华消化内镜杂志 Pub Date : 2019-05-20 DOI:10.3760/CMA.J.ISSN.1007-5232.2019.05.005

Yongqiu Wei, Qiaozhi Zhou, Peng Li, M. Ji, Y. Niu, Yong-jun Wang, Shutian Zhang

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Abstract

Objective To study the therapeutic value of endoscopy for primary duodenal lesions. Methods Data of 79 consecutive patients with primary duodenal lesions, who underwent endoscopic treatment from January 2015 to January 2018 at Beijing Friendship Hospital, were retrospectively analyzed. Patients were divided into the complication group and the non-complication group, and further grouped according to lesion locations and endoscopic categories. Baseline data of patients, endoscopic treatment, wound closure method, pathological results, the occurrence and outcome of complications were studied. Results A total of 79 patients successfully went through endoscopic treatment, including 59 cases of endoscopic mucosal resection (EMR), 5 cases of endoscopic submucosal dissection (ESD), 6 cases of full-thickness resection with OTSC metal clips, and 9 cases of endoscopic piecemeal mucosal resection (EPMR). In all 79 cases, complications occurred in 8 patients (10.1%) during the perioperative period, all at the duodenal descending segment and duodenal papilla. In all 47 cases whose lesions located at duodenal papilla and duodenal descending segment, the complication incidence was 17.0% (8/47), significantly higher than that of non-descending and papilla part [0 (0/32), P=0.012]. Two (2.5%) cases had complications requiring further intervention with endoscopy or surgery. Among 8 patients with complications, 1 patient (2.1%) developed intraoperative perforation, 1 patient (2.1%) developed delayed bleeding, 6 patients (12.8%) developed mild acute pancreatitis, and these 8 patients recovered after treatment. These 47 patients were further divided into the duodenoscopy group and the gastroscopy group according to endoscopic categories, the complications incidence in the duodenoscopy group (28.0%, 7/25) was also significantly higher than that in the gastroscopy group [4.5%(1/22), P=0.037]. Conclusion Endoscopic treatment is safe and effective for primary duodenal lesions. But for the operations in the duodenal descending segment and the duodenal papilla, as well as in the case of duodenoscopy, it is necessary to be more vigilant about the occurrence of complications. Key words: Duodenal disease; Endoscopy; Endoscopic mucosal resection; Endoscopic submucosal dissection

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内镜对原发性十二指肠病变的治疗价值

目的探讨内镜对原发性十二指肠病变的治疗价值。方法回顾性分析2015年1月至2018年1月在北京友谊医院接受内镜治疗的79例原发性十二指肠病变患者的资料。将患者分为并发症组和非并发症组，并根据病变部位和内镜类别进一步分组。研究了患者的基线数据、内镜治疗、伤口闭合方法、病理结果、并发症的发生和转归。结果共有79例患者成功接受了内镜治疗，其中内镜黏膜切除术（EMR）59例，内镜黏膜下剥离术（ESD）5例，OTSC金属夹全厚度切除术6例，内镜粘膜碎片切除术（EPMR）9例。在所有79例病例中，8例（10.1%）患者在围手术期出现并发症，均发生在十二指肠降段和十二指肠乳头。病变位于十二指肠乳头和十二指肠降段的47例患者中，并发症发生率为17.0%（8/47），明显高于非降段和十二指肠乳头部分[0（0/32），P=0.012]。2例（2.5%）出现并发症，需要进一步进行内镜或手术干预。在8名并发症患者中，1名患者（2.1%）出现术中穿孔，1名（2.1%）发生延迟性出血，6名患者（12.8%）出现轻度急性胰腺炎，这8名患者在治疗后康复。根据内镜类型将47例患者进一步分为十二指肠镜组和胃镜组，十二指肠镜组并发症发生率（28.0%，7/25）也明显高于胃镜组[4.5%（1/22），P=0.037]。结论内镜治疗原发性十二指肠病变安全有效。但对于十二指肠降段和十二指肠乳头的手术，以及十二指肠镜检查的情况，有必要对并发症的发生提高警惕。关键词：十二指肠疾病；内窥镜；内镜黏膜切除术；内镜黏膜下剥离术

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来源期刊

中华消化内镜杂志

CiteScore

0.10

自引率

0.00%

发文量

7555

期刊介绍： Chinese Journal of Digestive Endoscopy is a high-level medical academic journal specializing in digestive endoscopy, which was renamed Chinese Journal of Digestive Endoscopy in August 1996 from Endoscopy. Chinese Journal of Digestive Endoscopy mainly reports the leading scientific research results of esophagoscopy, gastroscopy, duodenoscopy, choledochoscopy, laparoscopy, colorectoscopy, small enteroscopy, sigmoidoscopy, etc. and the progress of their equipments and technologies at home and abroad, as well as the clinical diagnosis and treatment experience. The main columns are: treatises, abstracts of treatises, clinical reports, technical exchanges, special case reports and endoscopic complications. The target readers are digestive system diseases and digestive endoscopy workers who are engaged in medical treatment, teaching and scientific research. Chinese Journal of Digestive Endoscopy has been indexed by ISTIC, PKU, CSAD, WPRIM.