Exposed endoscopic full-thickness resection for duodenal submucosal tumors: Current status and future perspectives

Abstract

Exposed endoscopic full-thickness resection (EFTR), with or without laparoscopic assistance, is an emergent natural orifice transluminal endoscopic surgery technique with promising safety and efficacy for the management of gastrointestinal submucosal tumors (SMTs) arising from the muscularis propria (MP), especially of the gastric wall. To date, evidence concerning duodenal exposed EFTR is lacking, mainly due to both the technical difficulty involved because of the special duodenal anatomy and concerns about safety and effectiveness of transmural wall defect closure. However, given the non-negligible morbidity and mortality associated with duodenal surgery, the recent availability of dedicated endoscopic tools for tissue-approximation capable to realize full-thickness defect closure could help in promoting the adoption of this endosurgical technique among referral centers. The aim of our study was to review the current evidence concerning exposed EFTR with or without laparoscopic assistance for the treatment of MP-arising duodenal SMTs.

Keywords: Duodenal submucosal tumors; Endoscopic full-thickness resection; Exposed endoscopic full-thickness resection; Laparoscopy-assisted endoscopic full-thickness resection; Novel oral transluminal endoscopic surgery.

Figure 1

Duodenal exposed endoscopic full-thickness resection without laparoscopic assistance with defect closure using endoscopic suturing system. A: Endoscopic view of a submucosal lesion located in the duodenal bulb; B: Circumferential mucosal and submucosal incision; C: Exposed endoscopic full-thickness resection of the tumor and creation of “active perforation”; D: Transmural defect of the duodenal bulb; E: Full-thickness defect closure by means of OverStitch endoscopic suturing system; F: Endoscopic view of the resection site on post-operative day 60.