| Theme | Perforation and it's Management in Endoscopy | |
|---|---|---|
| Title | Perforation and its Management in the Duodenum | |
| Publish Date | 2010/02 | |
| Author | Satoru Nonaka | Endoscopy Division, National Cancer Center Hospital |
| Author | Ichiro Oda | Endoscopy Division, National Cancer Center Hospital |
| Author | Kazuhiro Tada | Endoscopy Division, National Cancer Center Hospital |
| Author | Shigetaka Yoshinaga | Endoscopy Division, National Cancer Center Hospital |
| Author | Takeshi Nakajima | Endoscopy Division, National Cancer Center Hospital |
| Author | Takahisa Matsuda | Endoscopy Division, National Cancer Center Hospital |
| Author | Yutaka Saito | Endoscopy Division, National Cancer Center Hospital |
| Author | Takuji Gotoda | Endoscopy Division, National Cancer Center Hospital |
| [ Summary ] | It is most difficult to perform endoscopic resections in the duodenum because of its anatomical features. Duodenal lesions that require endoscopic treatment are very few in number so the definition of early cancer in the duodenum, the criteria for a curative resection and the most likely candidates for such resections have not been established yet. Currently, duodenal adenomas, cancers and carcinoid tumors are candidates for endoscopic resection, but the procedure has generally been limited so far to adenomas, intramucosal cancers and carcinoid tumors <10 mm in size. Perforation is the complication that endoscopists should be most concerned about in the duodenum. Small perforations are usually managed endoscopically, however, and both sodium hyaluronate and carbon dioxide insufflation can be used to help prevent duodenal perforations. Endoscopists must keep in their mind a possibility of delayed perforation after endoscopic resections of duodenal lesions in order to explose the bile and pancreatic juice. It is recommended that only highly skilled endoscopists perform endoscopic resections in the duodenum due to the technical difficulty involved in such procedures. | |