title: Duodenal endoscopic full-thickness resection (with video).
abstract: OBJECTIVE
  Endoscopic resection of duodenal non-lifting adenomas and subepithelial tumors is challenging and harbors a significant risk of adverse events. We report on a novel technique for duodenal endoscopic full-thickness resection (EFTR) by using an over-the-scope device.
  
  
  METHODS
  Data of 4 consecutive patients who underwent duodenal EFTR were analyzed retrospectively. Main outcome measures were technical success, R0 resection, histologic confirmation of full-thickness resection, and adverse events. Resections were done with a novel, over-the-scope device (full-thickness resection device, FTRD).
  
  
  RESULTS
  Four patients (median age 60 years) with non-lifting adenomas (2 patients) or subepithelial tumors (2 patients) underwent EFTR in the duodenum. All lesions could be resected successfully. Mean procedure time was 67.5 minutes (range 50-85 minutes). Minor bleeding was observed in 2 cases; blood transfusions were not required. There was no immediate or delayed perforation. Mean diameter of the resection specimen was 28.3 mm (range 22-40 mm). Histology confirmed complete (R0) full-thickness resection in 3 of 4 cases. To date, 2-month endoscopic follow-up has been obtained in 3 patients. In all cases, the over-the-scope clip was still in place and could be removed without adverse events; recurrences were not observed.
  
  
  CONCLUSIONS
  EFTR in the duodenum with the FTRD is a promising technique that has the potential to spare surgical resections. Modifications of the device should be made to facilitate introduction by mouth. Prospective studies are needed to further evaluate efficacy and safety for duodenal resections.
authors.affiliation: Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany.
authors.forename: Arthur
authors.initials: A
authors.lastname: Schmidt
authors.affiliation: Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Meier
authors.affiliation: Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany.
authors.forename: Oscar
authors.initials: O
authors.lastname: Cahyadi
authors.affiliation: Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany.
authors.forename: Karel
authors.initials: K
authors.lastname: Caca
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D004379:Duodenal Neoplasms / Q000473:pathology / Q000601:surgery*; D004384:Duodenoscopy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome