Digestive Endoscopic Resection For The Treatment Of Duodenal Lesions Of21Cases

Background:With the continuous progress of science and technology in recent years, the treatment of gastrointestinal endoscopy technology is developing rapidly. Endoscopic mucosal resection (EMR) and Endoscopic submucosal dissection(ESD) is the representative endoscopic therapies.They have a small surgical trauma and can avoid changing the structure of the digestive tract by surgery.Besides,they present less postoperative pain, quick recovery.Thus they will significantly improve the quality of life of the patients. However, EMR and ESD technique in the treatment-of duodenal lesions is less coverage. One reason is the lower incidence of duodenal lesions.The duodenum lesions were hard to found because of duodenum’s specific anatomical site. The operators are required higher due to the special physiology and anatomy position of the duodenum.The operating space is relatively small, and the duodenal wall is thinner.The risks and harms of complications of the treatment are great. With the continuous development of endoscopic techniques and medical technology, clinical detection rate of duodenal lesions is greatly improved,So there are more duodenal lesions are treated by endoscopic minimally invasive treatment.Objective:To study the recent efficacy、complications and long-dated efficacy of endoscopic technique such as endoscopic mucosal resection(EMR) or endoscopic submucosal dissection(ESD)for duodenal lesion.Subjects and Methods:Retrospectively analyze the data of21hospitalized patients accordance with their clinical manifestations, on the basis of endoscopy and imaging data confirmed duodenal lesions with the treatment of endoscopic mucosal resection(EMR) or endoscopic submucosal dissection (ESD) clinical treatment between January2010to March2014.EMR surgery is divided into specific steps of mar、submucosal injection、snare resection and wound treatment. ESD surgery is divided into specific steps of mark、submucosal injection、edge cut、remove and wound treatment. A retrospective statistical analysis of patients with operation time, intraoperative and postoperative complications, hospitalization time, pathologic features. Analyze the long-term efficacy by telephone follow-up of the patients.Results:21patients with duodenal lesions were gave endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) clinical treatment under local or general anesthesia.The operations were almost smoothly. The lesion location included the duodenal bulb (4cases), the junction of bulb and descending part(6cases), the descending part (10cases), and the horizontal part (1case). No patients had intraoperative perforation.Two patients had postoperative lesions perforation, one healed by surgical therapy. Intraoperative hemorrhage occurred in seven patients.1patients with delayed bleeding, healed by medicine symptomatic treatment.4cases were of fever after surgery. Postoperative hospitalization time was4-30days.The average time was10days.Conclusion:Endoscopic mucosal resection(EMR) and Endoscopic submucosal dissection (ESD) treatment is two oncoming minimally invasive methods for the management of duodenal lesions with relatively less trauma, less pain and quick recovery.It’s effective and safe.However, the duodenal wall is thinner and operating space is relatively small because of its special anatomic site.It requires high skills for the operator.It’s difficult to avoid part of postoperative complications.The choice of treatment methods should be strictly in accordance with its surgical indications and contraindications.