title: Approach to the endoscopic resection of duodenal lesions.
abstract: Duodenal polyps or lesions are uncommonly found on upper endoscopy. Duodenal lesions can be categorized as subepithelial or mucosally-based, and the type of lesion often dictates the work-up and possible therapeutic options. Subepithelial lesions that can arise in the duodenum include lipomas, gastrointestinal stromal tumors, and carcinoids. Endoscopic ultrasonography with fine needle aspiration is useful in the characterization and diagnosis of subepithelial lesions. Duodenal gastrointestinal stromal tumors and large or multifocal carcinoids are best managed by surgical resection. Brunner's gland tumors, solitary Peutz-Jeghers polyps, and non-ampullary and ampullary adenomas are mucosally-based duodenal lesions, which can require removal and are typically amenable to endoscopic resection. Several anatomic characteristics of the duodenum make endoscopic resection of duodenal lesions challenging. However, advanced endoscopic techniques exist that enable the resection of large mucosally-based duodenal lesions. Endoscopic papillectomy is not without risk, but this procedure can effectively resect ampullary adenomas and allows patients to avoid surgery, which typically involves pancreaticoduodenectomy. Endoscopic mucosal resection and its variations (such as cap-assisted, cap-band-assisted, and underwater techniques) enable the safe and effective resection of most duodenal adenomas. Endoscopic submucosal dissection is possible but very difficult to safely perform in the duodenum.
authors.affiliation: Jonathan P Gaspar, Andrew Y Wang, Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, VA 22908, United States.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Gaspar
authors.affiliation: Jonathan P Gaspar, Andrew Y Wang, Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, VA 22908, United States.
authors.forename: Edward B
authors.initials: EB
authors.lastname: Stelow
authors.affiliation: Jonathan P Gaspar, Andrew Y Wang, Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, VA 22908, United States.
authors.forename: Andrew Y
authors.initials: AY
authors.lastname: Wang
mesh_terms: D018256:Adenomatous Polyps / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014670:Ampulla of Vater / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D001706:Biopsy; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004379:Duodenal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D020698:Duodenoscopes; D004384:Duodenoscopy / Q000009:adverse effects / Q000295:instrumentation; D019160:Endosonography; D004867:Equipment Design; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D007417:Intestinal Polyps / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D016717:Sphincterotomy, Endoscopic; D016896:Treatment Outcome
keywords: Adenoma; Ampulla; Duodenum; Endoscopic mucosal resection; Endoscopic submucosal dissection; Lesion; Papillectomy; Polyp; Subepithelial; Underwater
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