Feasibility Of Endoscopic Submucosal Dissection For Laterally Spreading Lesions Larger Than 20mm Located At The Second Part Of The Duodenum:A Single Centre Experience

Lateral spreading lesions (LSLs) of the duodenum sharing morphological and possibly biological commonalities with laterally spreading tumors (LSTs) of the colon usually encountered in the second part. Piecemeal EMR is commonly used for large such lesions (≥20mm), but its recurrence rate is high without precise pathological evaluation. Endoscopic submucosal dissection (ESD) can achieve complete resection regardless of lesion size, but it remains technical challenging for most endoscopists to operate in the duodenum. Studies on ESD for large LSLs are few . We reported our experience on therapeutic outcomes of ESD for for laterally spreading lesions larger than 20mm located at the second part of the duodenum. Patients with a laterally spreading lesion at the second part of the duodenum and measuring ≥20mm were included from March 2017 to August 2019 in our hospital. We carried out ESD for them after plenary examinations and followed them regularly. A total of consecutive 19 eligible patients with 19 lesions were performed ESD by the same highly skillful endoscopist (Dr Meidong Xu).The average lesion size was 2.6cm (ranging from 2.0-4.0 cm). The mean procedure time was 58.6min (20-117min), All 19 lesions were resected completely in one piece without involvement of the horizontal and vertical margins. No delayed bleeding was observed. Despite prophylactic clipping, two patients occurred delayed perforation nearly 24 hours after the ESD procedure and both of them received emergent open surgery because of diffuse peritonitis. Finally, Each patient made a full recovery and was discharged 2-3 months later without further adverse event. NO local recurrence was observed during the follow-up periods. Endoscopic submucosal dissection for laterally spreading lesions larger than 20mm located at the second part of the duodenum achieved satisfactory therapeutic outcomes in our experience. However, it demands performance by a highly skilled endoscopists due to associated procedural difficulties and high risks of complications.