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Toma et al. Mini-invasive Surg 2018;2:21 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2018.24

Original Article Open Access

Laparoscopic and endoscopic cooperative surgery
for non-ampullary duodenal epithelial neoplasms

Hiroki Toma , Kazuhiro Haraguchi , Kei Fujii , Tomonari Kobarai , Ichio Hirota , Toru Eguchi 1
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1 Department of Surgery, Harasanshin Hospital, Fukuoka 8120033, Japan.
2 Department of Gastroenterology, Harasanshin Hospital, Fukuoka 8120033, Japan.
Correspondence to: Dr. Hiroki Toma, Department of Surgery, Harasanshin Hospital, Fukuoka 8120033, Japan.
E-mail: toma@surg1.med.kyushu-u.ac.jp
How to cite this article: Toma H, Haraguchi K, Fujii K, Kobarai T, Hirota I, Eguchi T. Laparoscopic and endoscopic cooperative
surgery for non-ampullary duodenal epithelial neoplasms. Mini-invasive Surg 2018;2:21.
http://dx.doi.org/10.20517/2574-1225.2018.24
Received: 10 May 2018 First Decision: 25 Jun 2018 Revised: 13 Jul 2018 Accepted: 20 Jul 2018 Published: 31 Jul 2018

Science Editor: Charles F. Bellows Copy Editor: Jun-Yao Li Production Editor: Huan-Liang Wu

Abstract
Aim: We herein describe our initial experience of laparoscopic and endoscopic cooperative surgery (LECS) for non-
ampullary duodenal epithelial neoplasms (NADENs) and reveal its clinical significance.

Methods: This study included 5 consecutive patients treated by LECS for NADENs between April 2015 and January
2016 in our hospital. For surgery, R0-resection of NADENs was accomplished by endoscopic submucosal dissection
(ESD), and the mucosal defect resulting from ESD was subsequently repaired by laparoscopic seromuscular suture and
endoscopic clipping. Clinical records were reviewed retrospectively.

Results: LECS was accomplished in four patients. There was a case of open conversion due to the relatively large mucosal
defect resulting from ESD. In the postoperative course, no serious complications, including intra- and postoperative
bleeding and delayed perforation, were noted. The duodenal stenosis occurred in the case of open conversion but was
treated by repeated endoscopic balloon dilatation. Of the five lesions of NADENs, there were three adenomas and two
adenocarcinomas confined in the mucosa. To date, no tumor recurrence was observed during the postoperative course.

Conclusion: LECS is a promising procedure of choice in the treatment of NADENs, facilitating early resumption of both
food intake and full daily activity in the postoperative course.

Keywords: Endoscopic submucosal dissection, laparoscopic and endoscopic cooperative surgery, non-ampullary
duodenal epithelial neoplasms

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
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