Our Summary

This paper is about a type of growth or lesion that can occur in the duodenum, a part of the small intestine. There are two main types of these growths. One type, called subepithelial lesions, can include things like lipomas (a benign tumor made of fat tissue), gastrointestinal stromal tumors, and carcinoids (a type of slow-growing cancer). The other type of growth, called mucosally-based lesions, includes things like tumors of Brunner’s glands, solitary Peutz-Jeghers polyps, and adenomas.

The type of growth dictates the approach to treatment. Subepithelial lesions can be diagnosed using endoscopic ultrasonography with fine needle aspiration. Some types of these lesions, such as gastrointestinal stromal tumors and large or multifocal carcinoids, are best treated with surgery. Mucosally-based lesions, on the other hand, can often be removed endoscopically, meaning through the use of a specialized instrument guided through the mouth and into the duodenum.

The paper notes that the duodenum’s unique anatomical characteristics can make endoscopic removal of lesions challenging, but that advanced techniques exist that allow for the resection (or cutting out) of large mucosally-based lesions. One such technique, endoscopic papillectomy, can remove a type of adenoma and allow patients to avoid more invasive surgery.

Other techniques for endoscopic resection include endoscopic mucosal resection and its variations, which allow for the safe and effective removal of most duodenal adenomas. The paper also mentions endoscopic submucosal dissection, which is a more challenging procedure but which can also be done in the duodenum.

FAQs

  1. What types of duodenal lesions can be found on an upper endoscopy?
  2. How are duodenal lesions characterized and diagnosed?
  3. What are the different endoscopic techniques used for the resection of duodenal lesions?

Doctor’s Tip

A doctor might tell a patient who is undergoing intestinal resection to make sure to follow a strict post-operative diet and avoid foods that may cause irritation or blockages in the intestines. This can help promote healing and prevent complications after surgery. Additionally, staying hydrated and getting enough rest are important for a smooth recovery. It is also important to follow up with your healthcare provider regularly to monitor your progress and address any concerns that may arise.

Suitable For

Patients who are typically recommended intestinal resection include those with duodenal lesions such as subepithelial lesions like lipomas, gastrointestinal stromal tumors, and carcinoids, as well as mucosally-based lesions like Brunner’s gland tumors, solitary Peutz-Jeghers polyps, and non-ampullary and ampullary adenomas. In particular, patients with large or multifocal duodenal gastrointestinal stromal tumors, large or multifocal carcinoids, and ampullary adenomas may require surgical resection. Patients with mucosally-based duodenal lesions that cannot be effectively managed endoscopically may also be recommended for intestinal resection.

Timeline

  • Patient undergoes upper endoscopy and duodenal lesion is discovered
  • Lesion categorized as subepithelial or mucosally-based
  • Further work-up and possible therapeutic options considered
  • Endoscopic ultrasonography with fine needle aspiration used for characterization and diagnosis of subepithelial lesions
  • Surgical resection recommended for duodenal gastrointestinal stromal tumors and large or multifocal carcinoids
  • Mucosally-based duodenal lesions such as Brunner’s gland tumors, solitary Peutz-Jeghers polyps, and adenomas may require removal and can be treated with endoscopic resection
  • Advanced endoscopic techniques used for resection of large mucosally-based duodenal lesions
  • Endoscopic papillectomy may be performed to resect ampullary adenomas and avoid surgery
  • Endoscopic mucosal resection and its variations used for safe and effective resection of most duodenal adenomas
  • Endoscopic submucosal dissection is possible but challenging in the duodenum.

What to Ask Your Doctor

  1. What type of lesion do I have in my duodenum, and what are the potential risks associated with it?
  2. What are the different treatment options for my duodenal lesion, and what are the potential outcomes of each option?
  3. Do I need to undergo any additional tests or imaging studies to further evaluate the lesion before deciding on a treatment plan?
  4. How experienced are you in performing endoscopic resections of duodenal lesions, and what is the success rate of this procedure?
  5. What are the potential complications or side effects associated with endoscopic resection of duodenal lesions, and how will they be managed?
  6. Are there any alternative treatment options available for my duodenal lesion, such as surgical resection or watchful waiting?
  7. What is the recovery process like after undergoing an intestinal resection for a duodenal lesion, and how long can I expect to be in the hospital?
  8. How will my diet and lifestyle need to be modified after the procedure to ensure optimal healing and recovery?
  9. What are the long-term implications and follow-up care needed after undergoing an intestinal resection for a duodenal lesion?
  10. Are there any support groups or resources available for patients who have undergone similar procedures for duodenal lesions?

Reference

Authors: Gaspar JP, Stelow EB, Wang AY. Journal: World J Gastroenterol. 2016 Jan 14;22(2):600-17. doi: 10.3748/wjg.v22.i2.600. PMID: 26811610