Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.861
Filtrar
1.
Ann Ital Chir ; 102021 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-34738535

RESUMO

Gastrointestinal stromal tumors (GISTs) are rare tumors of the gastrointestinal tract, which cover about 1-2% of gastrointestinal neoplasms. They are more common in the stomach (40-60%) while a minor part in jejunum/ileus (25- 30%), duodenum (<5%), colorectal (5-15%) and esophagus (<1%). The clinical presentation depends on the primary localization of the neoplasma and tumor size, however in 18% it is asymptomatic. Gastrointestinal bleeding is the most dangerous complication, often necessitating emergency surgery and represents a common symptom of duodenal GIST. We present a case of a 82-year-old male presented with abdominal pain, asthenia and melena with haemodynamically stable. The patient underwent a recent coronary angioplasty and currently on double antiplatelet therapy. During observation a palpable mass was detected in the periumbilical region and right hypochondrium. A superior digestive endoscopy was performed which revealed an ab estrinseco compression of second duodenal segment and bleeding of third duodenal mucosa segment. No local haemostasis could be accomplished. An Angio-CT showed a large exophytic tumor arising from the 3th duodenal segment with approximately 13x9 cm, with apparent intratumoral bleeding. No indication for possible angioembolization. Due to gradual modification of the haemodynamic , the patient was submitted to emergency laparotomy. A segmental enterectomy was performed and the post-operative period ran without complications. The histopathologic exam showed a gastro-intestinal stromal tumor of epithelioid cell nature with low mitotic count (2 per 50HPF). The immunohistochemical analysis revealed positivity for CD117 (c-Kit) and DOG1 with Ki67<1%. KEY WORDS: Bleeding, Duodenal GIST, Gastrointestinal, Gastrointestinal stromal tumor.


Assuntos
Neoplasias Duodenais , Neoplasias Gastrointestinais , Tumores do Estroma Gastrointestinal , Idoso de 80 Anos ou mais , Neoplasias Duodenais/complicações , Neoplasias Duodenais/cirurgia , Duodeno , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Tumores do Estroma Gastrointestinal/complicações , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Masculino
2.
J Int Med Res ; 49(10): 3000605211053230, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34719989

RESUMO

Periampullary carcinoma refers to a malignant tumor within 2 cm of the duodenal ampulla. Primary ampullary carcinoma is very rare, accounting for only 0.2% of malignant gastrointestinal tumors. The small intestine accounts for 75% of the length of the gastrointestinal tract, and primary tumors in the small intestine account for only 2% of all gastrointestinal tumors. Here, we report the case of a duodenal ampullary tumor with malignant transformation of parapapillary polyps. The patient had both a primary ampullary tumor and high-grade intraepithelial neoplasia of juxtapapillary adenomatous duodenal polyps.


Assuntos
Carcinoma in Situ , Carcinoma , Neoplasias Duodenais , Pólipos , Carcinoma/patologia , Carcinoma in Situ/patologia , Neoplasias Duodenais/diagnóstico por imagem , Neoplasias Duodenais/patologia , Neoplasias Duodenais/cirurgia , Duodeno/patologia , Humanos , Pólipos/patologia
3.
Medicine (Baltimore) ; 100(39): e27382, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34596158

RESUMO

ABSTRACT: Sporadic non-ampullary duodenal adenoma (SNADA) is a rare disease, and therefore, its clinical characteristics have not been comprehensively investigated. Furthermore, owing to the high complication rates and severity of endoscopic resection, treatment strategies vary among facilities. In the present study, we aimed to clarify the clinical characteristics and course of SNADA.We extracted clinical and histological records of SNADA cases diagnosed in 11 hospitals between September 1999 and August 2014. The patients were divided into "no-resection" and "resection" groups based on the initial treatment approach. We investigated the long-term outcome of the "no-resection" group and treatment results of the "resection" group, with particular interest in endoscopic resection.Overall, 299 patients were diagnosed with SNADA. The median age at diagnosis was 67 years (range, 31-88 years), with approximately twice as many men as women. The median tumor size was 8.0 mm (2-60 mm). In total, 161 patients were initially selected for no-resection and 138 underwent resection. Age >70 years and the presence of either severe illness or poor performance status were significantly related to opting for no-resection. In the no-resection group, 101 patients underwent endoscopic follow-up for at least 1 year. During the observational period (2.5 ±â€Š2.2 years), 27 lesions (27%) disappeared following cold forceps biopsy, and 13 lesions (14%) presented lateral growth. Four lesions (4%) changed to mucosal carcinoma, 3 were treated endoscopically, and 1 was surgically resected. Nineteen patients died; however, no one died of duodenal carcinoma. In the endoscopic resection group, en bloc resection was achieved in 78% of patients. However, the complication rate for perforation was 7%, and endoscopic submucosal dissection was associated with a 36% perforation rate.With the low incidence of cancer development and no disease specific death, the strategy of initially not performing resection could be considered especially for the older adults, poor-prognosis patients, or small lesions.


Assuntos
Pólipos Adenomatosos/cirurgia , Neoplasias Duodenais/cirurgia , Pólipos Adenomatosos/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Neoplasias Duodenais/patologia , Endoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
6.
J Gastrointest Surg ; 25(11): 3013-3014, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34382156

RESUMO

In this video, we present the laparoscopic technique of pancreas-preserving segmental resection for GISTs of the 4th portion of the duodenum. A 54-year-old male presented with a polypoid mass of about 3 cm in diameter with a large base, in the 4th portion of the duodenum, about 4 cm from the ampulla. Multiple endoscopic biopsies were taken, and all were negative for adenocarcinoma. CT scan of the abdomen confirmed that the mass, suggestive of GIST, was limited to the duodenum, a limited part intraluminal and the vast majority in the duodenal wall. A laparoscopic segmental resection with a 3D video system was accomplished. The operation lasted 160 min. Recovery was uneventful.


Assuntos
Ampola Hepatopancreática , Neoplasias Duodenais , Tumores do Estroma Gastrointestinal , Laparoscopia , Neoplasias Duodenais/diagnóstico por imagem , Neoplasias Duodenais/cirurgia , Duodeno/diagnóstico por imagem , Duodeno/cirurgia , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Pâncreas/diagnóstico por imagem , Pâncreas/cirurgia
7.
Khirurgiia (Mosk) ; (8): 11-19, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34363440

RESUMO

OBJECTIVE: To evaluate the immediate and long-term results of surgical and combined treatment of patients with duodenal stromal tumors. MATERIAL AND METHODS: There were 47 patients with duodenal stromal tumors for the period 2002-2019. All patients underwent treatment at the Blokhin National Cancer Research Center. Six patients had metastatic disease, 2 ones - a rare syndrome of duodenal stromal tumor associated with neurofibromatosis type 1, other 39 patients had a localized and locally-advanced disease. Surgical treatment was performed in 37 patients (limited resections (LR) in 24 cases and gastropancreaticoduodenectomy in 13 cases).Incidence of postoperative complications was significantly lower after limited resections compared to gastropancreaticoduodenectomy (22.2% (6/24) vs. 61.5% (8/13), respectively). Severe complications (Clavien-Dindo grade 3) occurred in 4.2% (1/24) vs. 15.3% (2/13) of patients, respectively. Postoperative mortality was absent in both groups. We observed no significant differences in long-term results. Overall 5-year survival was 91% and 70% (p=0.5960), 5-year recurrence-free survival - 65 and 70% (p=0.6226), respectively. CONCLUSION: Considering similar survival rates, lower postoperative morbidity and better quality of life, limited duodenal resections are preferred for duodenal stromal tumors.


Assuntos
Neoplasias Duodenais , Tumores do Estroma Gastrointestinal , Neoplasias Duodenais/diagnóstico , Neoplasias Duodenais/cirurgia , Tumores do Estroma Gastrointestinal/diagnóstico , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Pancreaticoduodenectomia/efeitos adversos , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento
8.
Khirurgiia (Mosk) ; (8): 125-130, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34363455

RESUMO

Gastrointestinal stromal duodenal tumors are rare diseases of small intestine. Duodenal GISTs may be giant; these neoplasms can also simulate malignancies of other organs. These features result diagnostic and treatment mistakes. Neoadjuvant therapy with imatinib results tumor shrinkage and ensures organ-sparing surgery. We report duodenal GISTs in patients with primary diagnosis «retroperitoneal tumor¼, «pancreatic cyst¼ and «retroperitoneal abscess¼, who were treated at the Blokhin National Cancer Research Centre in 2019-2020.


Assuntos
Neoplasias Duodenais , Tumores do Estroma Gastrointestinal , Neoplasias Duodenais/diagnóstico , Neoplasias Duodenais/cirurgia , Duodeno , Tumores do Estroma Gastrointestinal/diagnóstico , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Mesilato de Imatinib , Terapia Neoadjuvante
10.
Ann Surg Oncol ; 28(13): 8318-8328, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34312800

RESUMO

BACKGROUND: Ampullary neuroendocrine tumors (NETs) make up < 1% of all gastroenteropancreatic NETs, and information is limited to case series. This study compares patients with ampullary, duodenal, and pancreatic head NETs. METHODS: The National Cancer Database (2004-2016) was queried for patients with ampullary, duodenal, and pancreatic head NETs. Survival was evaluated using Kaplan-Meier analysis and Cox regression. RESULTS: Overall, 872, 9692, and 6561 patients were identified with ampullary, duodenal, and pancreatic head NETs, respectively. Patients with ampullary NETs had more grade 3 tumors (n = 149, 17%) than patients with duodenal (n = 197, 2%) or pancreatic head (n = 740, 11%) NETs. Patients with ampullary NETs had more positive lymph nodes (n = 297, 34%) than patients with duodenal (n = 950, 10%) or pancreatic head (n = 1513, 23%) NETs. On multivariable analysis for patients with ampullary NETs, age (hazard ratio [HR] 1.03, p < 0.0001), Charlson-Deyo score of 2 (HR 2.3, p = 0.001) or ≥3 (HR 2.9, p = 0.013), grade 2 (HR 1.9, p = 0.007) or grade 3 tumors (HR 4.0, p < 0.0001), and metastatic disease (HR 2.0, p = 0.001) were associated with decreased survival. At 5 years, the overall survival (OS) for patients with ampullary, duodenal, and pancreatic head NETs was 59%, 71%, and 50%, respectively (p < 0.0001), whereas the 5-year OS for patients with ampullary, duodenal, and pancreatic head NETs who underwent surgery was 62%, 78%, and 76%, respectively (p < 0.0001). CONCLUSIONS: Ampullary NETs were more likely to present with high-grade tumors and lymph node metastases. Based on the clinicopathologic and survival data, ampullary NETs have a unique underlying biology compared with duodenal and pancreatic head NETs.


Assuntos
Neoplasias do Ducto Colédoco , Neoplasias Duodenais , Tumores Neuroendócrinos , Neoplasias Pancreáticas , Neoplasias do Ducto Colédoco/cirurgia , Neoplasias Duodenais/cirurgia , Humanos , Tumores Neuroendócrinos/cirurgia , Modelos de Riscos Proporcionais
11.
Rev Esp Enferm Dig ; 113(11): 793-794, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34320812

RESUMO

We present the case of an 81-year-old male with a history of surgically resected colorectal and bladder cancer, who was admitted to our hospital with a urinary infection. A routine renal ultrasound showed a pelvic cyst and a CT scan confirmed a non-complicated cyst, but a lesion was observed in the left lung. He underwent a PET-CT in which an unexpected enhancement of the small bowel attracted our attention.


Assuntos
Adenocarcinoma , Neoplasias Duodenais , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/cirurgia , Idoso de 80 Anos ou mais , Neoplasias Duodenais/diagnóstico por imagem , Neoplasias Duodenais/cirurgia , Duodeno , Humanos , Masculino , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Ultrassonografia
12.
BMJ Case Rep ; 14(7)2021 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-34261636

RESUMO

Primary adenocarcinoma of the fourth portion of the duodenum (D-IV) is reported infrequently than other parts of the duodenum. Its diagnosis is often late because of non-specific symptoms and signs. We encountered a 48-year-old male patient who was diagnosed as duodeno-duodenal intussusception, underwent segmental duodenal resection with duodenojejunal anastomosis and confirmed as adenocarcinoma of D-IV. He received adjuvant chemotherapy and is doing well at 1 year of follow-up. This report describes about the rare case of isolated adenocarcinoma of the D-IV presented as intussusception which is never reported before and successfully treated by segmental resection of the duodenum and jejunum.


Assuntos
Adenocarcinoma , Neoplasias Duodenais , Intussuscepção , Adenocarcinoma/complicações , Adenocarcinoma/diagnóstico , Adenocarcinoma/cirurgia , Neoplasias Duodenais/complicações , Neoplasias Duodenais/diagnóstico , Neoplasias Duodenais/cirurgia , Duodeno/diagnóstico por imagem , Duodeno/cirurgia , Humanos , Intussuscepção/etiologia , Intussuscepção/cirurgia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
13.
Khirurgiia (Mosk) ; (7): 49-56, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34270194

RESUMO

OBJECTIVE: To develop the indications and assess an effectiveness of treatment of patients with ampullary tumors followed by mechanical jaundice. MATERIAL AND METHODS: There were 26 patients with major duodenal papilla neoplasms for the period 2015-2020 at the Sklifosovsky Research Institute for Emergency Care. RESULTS: Twenty patients underwent transpapillary interventions: papillosphincterotomy followed by lithoextraction and bilio-duodenal stenting in 4 (15.3%) patients, bilio-duodenal stenting in 12 (46.1%) patients, nasobiliary drainage in 2 (7.6%) patients, pancreaticoduodenal stenting in 2 (7.6%) patients. Percutaneous transhepatic microcholecystostomy was performed in 6 (23.4%) patients. In all cases, laboratory values decreased in 5-7 days after drainage. Eight (30.7%) patients refused further surgical treatment and were discharged in satisfactory condition. Another 8 (44.5%) patients underwent endoscopic submucosal papillectomy. There were no postoperative complications. Patients were discharged after 5-7 days. Four (22.2%) patients underwent tumor resection via laparotomy. One of these patients required redo laparotomy in postoperative period due to acute perforated duodenal ulcer. Six (33.3%) patients underwent palliative bilio-duodenal stenting. CONCLUSION: Invasion of muscle layer or distal parts of the common bile duct, as well as abnormal vascularization are indications for open surgery or palliative endoscopic treatment. Tumor location within mucous and muscle layers without invasion of distal third of the common bile duct and no abnormal vascularization of tumor justify endoscopic papillectomy. Endoscopic approach can be considered as a final minimally invasive method with minimal risk of postoperative complications in case of benign ampullary tumor.


Assuntos
Ampola Hepatopancreática , Neoplasias do Ducto Colédoco , Neoplasias Duodenais , Icterícia Obstrutiva , Ampola Hepatopancreática/cirurgia , Neoplasias do Ducto Colédoco/complicações , Neoplasias do Ducto Colédoco/diagnóstico , Neoplasias do Ducto Colédoco/cirurgia , Neoplasias Duodenais/complicações , Neoplasias Duodenais/diagnóstico , Neoplasias Duodenais/cirurgia , Humanos , Icterícia Obstrutiva/diagnóstico , Icterícia Obstrutiva/etiologia , Icterícia Obstrutiva/cirurgia , Resultado do Tratamento
14.
Chirurg ; 92(9): 796-802, 2021 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-34258646

RESUMO

BACKGROUND: Endoscopically unresectable adenomas and carcinomas of the greater duodenal papilla and ampulla of the bile duct necessitate surgical resection. The surgical techniques need to be adapted to local tumor expansion and patterns of infiltrative growth. OBJECTIVE: Based on the current scientific data and developments this article provides an overview of indications for surgical resection, surgical strategies and dissection techniques for ampullary tumors. MATERIAL AND METHODS: A review of the literature addressing surgical management of ampullary neoplasms was performed. Current evidence and recommendations were summarized. RESULTS AND CONCLUSION: Ampullary neoplasms can originate from intestinal or pancreatobiliary epithelial cells. Differentiating these histopathological subtypes is of crucial relevance concerning therapeutic strategy and prognosis in ampullary adenocarcinoma. All ampullary adenomas carry a risk of malignant transformation and therefore justify resection. Endoscopic papillectomy, surgical transduodenal ampullectomy and partial pancreatoduodenectomy are suitable resection techniques for ampullary adenoma. The selection of the procedure depends on intraductal tumor extension, tumor size and degree of dysplasia. Ampullary carcinoma is managed by upfront pancreatoduodenectomy comprising systematic lymph node dissection and level II dissection of the mesopancreas. Lymph node status and perineural sheath invasion are key prognostic factors concerning overall survival.


Assuntos
Ampola Hepatopancreática , Neoplasias do Ducto Colédoco , Neoplasias Duodenais , Neoplasias Pancreáticas , Ampola Hepatopancreática/cirurgia , Neoplasias do Ducto Colédoco/cirurgia , Neoplasias Duodenais/cirurgia , Humanos , Pancreaticoduodenectomia , Estudos Retrospectivos , Resultado do Tratamento
15.
Chirurg ; 92(9): 771-775, 2021 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-34264368

RESUMO

BACKGROUND: Approximately 30-40% of pancreatoduodenectomies for adenocarcinomas result in nonpancreatic periampullary adenocarcinoma as the final diagnosis. Depending on the origin, a distinction is made between four different carcinomas with histomorphological subtypes. OBJECTIVE: Carcinoma location and subtype are of prognostic and therapeutic relevance; however, the preoperative differentiation is often incorrect despite modern diagnostics. MATERIAL AND METHODS: Overview of the current literature on the classification and preoperative diagnostics of periampullary adenocarcinomas. RESULTS: A precise knowledge of the papillary anatomy is necessary for the correct classification of diagnostic findings. Current studies demonstrate diagnostically valuable information from the anamnesis, imaging and endoscopy. CONCLUSION: In ca. 70-80% of cases a correct diagnosis of the type of periampullary adenocarcinoma is possible on the basis of interdisciplinary diagnostics. This potentially enables a correspondingly individualized treatment planning in the preoperative phase.


Assuntos
Adenocarcinoma , Ampola Hepatopancreática , Neoplasias do Ducto Colédoco , Neoplasias Duodenais , Neoplasias Pancreáticas , Adenocarcinoma/cirurgia , Ampola Hepatopancreática/cirurgia , Neoplasias do Ducto Colédoco/cirurgia , Neoplasias Duodenais/cirurgia , Humanos , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia
17.
Am J Surg Pathol ; 45(12): 1694-1702, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34138799

RESUMO

Nonampullary duodenal adenomas (NADAs) develop sporadically or in the setting of a hereditary syndrome such as familial adenomatous polyposis (FAP). Although they are thought to progress into duodenal adenocarcinomas via an adenoma to carcinoma sequence similar to colorectal cancer, limited data suggested that they may be biologically dissimilar to colorectal adenomas. The clinicopathologic features of 71 patients diagnosed with NADAs (37 FAP and 34 sporadic) were analyzed. From the 71 patients, 89 NADA biopsies (42 FAP and 47 sporadic) were evaluated by DNA flow cytometry. Eighty-two samples showed low-grade dysplasia, and 7 demonstrated high-grade dysplasia (HGD). Twenty-one low-grade adenomas of the ileal pouch (n=19) and jejunum (n=2) from 15 FAP patients who underwent total proctocolectomy were also analyzed by DNA flow cytometry. The FAP patients were more likely to be younger (mean: 28 y) and have multifocal disease (92%) than the sporadic patients (66 y and 24%, respectively) (P<0.001). Most NADAs presented as polypoid lesions (87%) in the duodenal bulb and/or second portion of the duodenum (94%). Sporadic NADAs (mean: 2.4 cm) were significantly larger than FAP-related NADAs (1.3 cm) (P=0.005). Three (4%) patients (2 sporadic and 1 FAP) had high-grade NADAs at the first endoscopy, while the remaining 68 (96%) patients had low-grade dysplasia. Two additional sporadic and 1 FAP patients developed HGD on follow-up. Although the overall detection rate of advanced neoplasia (either HGD or adenocarcinoma) was similar between the FAP (n=5; 14%) and sporadic groups (n=4; 12%) (P=1.000), 3 FAP patients (all with Spigelman stage III to IV) developed adenocarcinoma in the duodenum (n=2) or in the ileal pouch (n=1) within a mean follow-up time of 76 months, while no adenocarcinoma was found in the sporadic group. Of the 37 FAP patients, 29 (78%) had a history of total proctocolectomy, and 15 (52%) developed low-grade adenomas in the ileal pouch with (n=2) or without (n=13) jejunal involvement (vs. 0% in the sporadic patients, P<0.001). All 15 patients had ≥Spigelman stage II. Aneuploidy was detected in only 1 (1%) sporadic NADA with HGD, whereas the remaining 109 duodenal, ileal pouch, and jejunal adenomas showed normal DNA content. The overall 3-, 9-, and 15-year detection rates of adenocarcinoma (in the duodenum and ileal pouch) in all NADA patients were 1.4%, 7.2%, and 18.8%, respectively. Three-, 9-, and 15-year detection rates of adenocarcinoma in the FAP patients were 2.7%, 9.7%, and 22.6%, respectively, while these rates remained at 0% in the sporadic patients. In conclusion, FAP-related NADAs have distinct clinicopathologic features compared with their sporadic counterpart. However, the vast majority of both FAP-related and sporadic NADAs (99%) lack the DNA content abnormality that is characteristic of the typical adenoma-carcinoma sequence involved in other gastrointestinal carcinogenesis. Although adenocarcinoma is more likely to develop in FAP patients with a high adenoma burden, probably due to the higher likelihood that some advanced lesions are missed endoscopically, FAP-related and sporadic NADAs may have a comparable risk of developing advanced neoplasia on a per-adenoma basis.


Assuntos
Adenocarcinoma/genética , Polipose Adenomatosa do Colo/genética , Aneuploidia , DNA de Neoplasias/genética , Neoplasias Duodenais/genética , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Polipose Adenomatosa do Colo/patologia , Polipose Adenomatosa do Colo/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Criança , Progressão da Doença , Neoplasias Duodenais/patologia , Neoplasias Duodenais/cirurgia , Feminino , Citometria de Fluxo , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Medição de Risco , Fatores de Risco , Adulto Jovem
18.
Medicine (Baltimore) ; 100(23): e26267, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34115021

RESUMO

ABSTRACT: Endoscopic resection (ER) for non-ampullary duodenal lesions (NADLs) is technically more difficult than lesions of the stomach. However, endoscopic treatment of duodenal lesions has been increasingly performed in recent years. This study aimed to evaluate the efficacy and safety of ER for NADLs.Patients who underwent ER for NADLs between 2004 and 2019 were retrospectively reviewed. Clinical and pathologic features of the lesions including the clinical outcomes and adverse events were analyzed.The study included 80 patients with NADLs. The mean age of patients was 59.3 years (22-80 years), the mean size of the lesion was 8.8 ±â€Š7.0 mm, and the mean procedure time was 13.2 ±â€Š11.2 min. Half (40/80) of the lesions were in the duodenal bulb including the superior duodenal angle. Final histological data showed 56 adenomas (70.5%), 13 Brunner gland tumors (16.2%), and 4 pyloric gland tumors (5.0%). The final diagnoses of 5 lesions after ER showed higher-grade dysplasia compared to pre-ER biopsy findings. The en bloc resection rate was 93.8% (75/80), and the complete resection rate with clear margins was 90.0% (72/80). Micro-perforation occurred in 2 of 80 patients and was successfully treated with conservative treatment. There were no cases of delayed bleeding. The mean follow-up period was 27.0 months (2-119 months) with no cases of recurrence.ER may be an effective treatment for NADLs with favorable long-term outcomes. However, the possibility of perforation complications should always be considered during ER.


Assuntos
Adenoma , Neoplasias Duodenais , Duodenoscopia , Ressecção Endoscópica de Mucosa , Complicações Intraoperatórias , Adenoma/epidemiologia , Adenoma/patologia , Adenoma/cirurgia , Biópsia/métodos , Neoplasias Duodenais/epidemiologia , Neoplasias Duodenais/patologia , Neoplasias Duodenais/cirurgia , Duodenoscopia/efeitos adversos , Duodenoscopia/métodos , Duodeno/diagnóstico por imagem , Duodeno/patologia , Duodeno/cirurgia , Ressecção Endoscópica de Mucosa/efeitos adversos , Ressecção Endoscópica de Mucosa/métodos , Feminino , Humanos , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/prevenção & controle , Efeitos Adversos de Longa Duração/epidemiologia , Efeitos Adversos de Longa Duração/prevenção & controle , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Recidiva , República da Coreia/epidemiologia , Estudos Retrospectivos
19.
N Z Med J ; 134(1536): 77-85, 2021 06 04.
Artigo em Inglês | MEDLINE | ID: mdl-34140714

RESUMO

BACKGROUND: Endoscopically placed duodenal stents are commonly performed procedures for palliation of obstruction due to malignancy. A relatively small number of studies highlight the potential complications of this procedure, and to date no data have been published in New Zealand specifically addressing this issue. We aimed to retrospectively review complications from duodenal stents at our center and factors associated with the complications. METHOD: We retrospectively reviewed our endoscopy reporting system, Provation MD, for patients who underwent endoscopic duodenal stenting between 1 April 2010 and 31 March 2020. We searched the system for the keywords 'prosthesis or stent', 'duodenal mass or tumour' and 'duodenal stenosis or stricture'. Their clinical records were reviewed. Patients were included if they had a duodenal stent inserted to relieve a malignant duodenal obstruction. Patients were excluded if the obstruction was due to a benign pathology or if the obstruction was proximal to duodenum. Patient demographics, the type of stent used and any stent-related complications were recorded. Previous radiotherapy to chest or abdomen was also recorded. RESULTS: We identified 61 patients who underwent palliative endoscopic duodenal stenting. The overall complication rate was 15% (9/61), with five cases of stent migration, two cases of perforation and two cases of late tumour ingrowth requiring re-stenting. Three out of five stent-migration cases had non-obstructive lesions. Both the cases of perforation had previous radiotherapy. CONCLUSION: Duodenal stenting can be performed safely in most patients with malignant duodenal obstruction. The complication rate was found to be higher among the 60-69 age group, the New Zealand Maori/Pacific Islander ethnic group, patients with Niti-S stent and those with duodenal adenocarcinoma as the primary diagnosis, but these higher rates were not found to be statistically significant. Larger studies are required to assess factors associated with complication rates.


Assuntos
Neoplasias Duodenais/cirurgia , Obstrução Duodenal/cirurgia , Duodenoscopia , Complicações Pós-Operatórias/epidemiologia , Stents/efeitos adversos , Idoso , Duodenoscopia/efeitos adversos , Duodenoscopia/métodos , Duodenoscopia/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Grupo com Ancestrais Oceânicos , Estudos Retrospectivos
20.
Clin J Gastroenterol ; 14(5): 1464-1469, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34117599

RESUMO

Duodenal gastrointestinal stromal tumors (dGISTs) are rare, and a lack of consensus exists regarding their treatment, particularly for recurrent disease. We herein report a rare case of liver metastasis 7 years after resection of a low-risk duodenal gastrointestinal stromal tumor. A 45-year-old woman revealed positive fecal occult blood. Upper gastrointestinal endoscopy revealed a submucosal duodenal tumor with ulceration and oozing on the apex. Endoscopic ultrasound showed a hypoechoic mass originating in the submucosa. Contrast-enhanced abdominal computed tomography (CT) revealed a 30-mm hyper-vascular tumor in the duodenal bulb. The patient underwent partial resection of the duodenal bulb with distal gastrectomy, followed by Roux-en-Y reconstruction. Histopathological evaluation revealed a tumor comprised of spindle-shaped cells including 5 mitotic figures per 50 high-power fields. Immunohistochemical evaluation indicated that the tumor cells were positive for c-Kit and CD34 expression. The tumor was diagnosed as low-risk dGIST. Postoperative follow-up was continued, and 7 years later, CT revealed a 39-mm enhanced tumor in liver segment 4. The tumor was diagnosed as a metastatic liver tumor, and the patient underwent S4 partial hepatectomy. As a result of histological and immunohistochemical analysis, the tumor was diagnosed as a liver metastasis from dGIST. The patient has been receiving oral imatinib 400 mg daily and remains free of disease 5 years after her last surgery. Low-risk dGIST can metastasize relatively long after surgery. However, an excellent long-term prognosis may be achieved by combining complete resection and imatinib therapy in patients with recurrent liver metastases.


Assuntos
Neoplasias Duodenais , Tumores do Estroma Gastrointestinal , Neoplasias Hepáticas , Neoplasias Duodenais/diagnóstico por imagem , Neoplasias Duodenais/cirurgia , Duodeno , Feminino , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Mesilato de Imatinib/uso terapêutico , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Pessoa de Meia-Idade
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...