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World J Gastroenterol. Nov 7, 2015; 21(41): 11832-11841
Published online Nov 7, 2015. doi: 10.3748/wjg.v21.i41.11832
Preoperative endoscopic diagnosis of superficial non-ampullary duodenal epithelial tumors, including magnifying endoscopy
Shigetsugu Tsuji, Hisashi Doyama, Kunihiro Tsuji, Sho Tsuyama, Kei Tominaga, Naohiro Yoshida, Kenichi Takemura, Shinya Yamada, Hideki Niwa, Kazuyoshi Katayanagi, Hiroshi Kurumaya, Toshihide Okada
Shigetsugu Tsuji, Hisashi Doyama, Kunihiro Tsuji, Kei Tominaga, Naohiro Yoshida, Kenichi Takemura, Shinya Yamada, Toshihide Okada, Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa 920-8530, Japan
Sho Tsuyama, Hideki Niwa, Kazuyoshi Katayanagi, Hiroshi Kurumaya, Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa 920-8530, Japan
Author contributions: Tsuji S, Doyama H, Tsuji K, Tsuyama S, Tominaga K, Yosihda N, Takemura K, Yamada S, Niwa H, Katayanagi K, Kurumaya H and Okada T contributed to study conception and design, acquisition of data, analysis and interpretation of data, drafting of the article and revising it critically for important intellectual content, and final approval of the version to be published.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hisashi Doyama, MD, PhD, Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kuratsuki-Higashi 2-1, Kanazawa, Ishikawa 920-8530, Japan. doyama.134@ipch.jp
Telephone: +81-76-2378211 Fax: +81-76-2382337
Received: April 14, 2015
Peer-review started: April 16, 2015
First decision: June 2, 2015
Revised: June 18, 2015
Accepted: August 31, 2015
Article in press: August 31, 2015
Published online: November 7, 2015
Processing time: 202 Days and 21.2 Hours
Abstract

Superficial non-ampullary duodenal epithelial tumor (SNADET) is defined as a sporadic tumor that is confined to the mucosa or submucosa that does not arise from Vater’s papilla, and it includes adenoma and adenocarcinoma. Recent developments in endoscopic technology, such as high-resolution endoscopy and image-enhanced endoscopy, may increase the chances of detecting SNADET lesions. However, because SNADET is rare, little is known about its preoperative endoscopic diagnosis. The use of endoscopic resection for SNADET, which has no risk of metastasis, is increasing, but the incidence of complications, such as perforation, is significantly higher than in any other part of the digestive tract. A preoperative diagnosis is required to distinguish between lesions that should be followed up and those that require treatment. Retrospective studies have revealed certain endoscopic findings that suggest malignancy. In recent years, several new imaging modalities have been developed and explored for real-time diagnosis of these lesion types. Establishing an endoscopic diagnostic tool to differentiate between adenoma and adenocarcinoma in SNADET lesions is required to select the most appropriate treatment. This review describes the current state of knowledge about preoperative endoscopic diagnosis of SNADETs, such as duodenal adenoma and duodenal adenocarcinoma. Newer endoscopic techniques, including magnifying endoscopy, may help to guide these diagnostics, but their additional advantages remain unclear, and further studies are required to clarify these issues.

Keywords: Endoscopy; Duodenoscopy; Duodenal neoplasms; Narrow band imaging; Pathology

Core tip: Because superficial non-ampullary duodenal epithelial tumor is rare, a preoperative endoscopic diagnostic technique to differentiate between adenoma and adenocarcinoma has not yet been established. Recently, many new imaging modalities have been developed and explored for use in the real-time diagnosis of these types of lesions. Newer endoscopic techniques, including magnifying endoscopy, may help to guide these diagnostics, but their additional advantages remain unclear, and further studies are required to clarify these issues.