Pathologic Evaluation of Endoscopically Resected Non-Ampullary Duodenal Lesions: A Single Center Experience

Abstract

Objective: Endoscopic resections are increasingly being used for superficial gastrointestinal lesions. However, application of these techniques inthe duodenum remains challenging, due to the technical difficulties and high complication rates. This study projects a western tertiary center’sexperience in the endoscopic treatment and diagnostic workup of 19 cases of non-ampullary duodenal lesions.Material and Method: Specimens (12 endoscopic mucosal resections, 6 endoscopic submucosal dissections, and one endoscopic full-thicknessresection) were processed following a strict protocol (photographed, mapped digitally and submitted totally) for histopathologic examination.Clinicopathologic characteristics, margin status and follow-up information were analyzed.Results: The mean age of the 16 patients was 52 years (range: 22-81). Mean lesion size was 1.4 cm (range: 0.3-3.6 cm) for all cases, 2 cmfor endoscopic submucosal dissections and 1.1 cm for endoscopic mucosal resections. Mean number of blocks submitted was 4/case. Sevenneuroendocrine tumors, 3 tubulovillous adenomas were diagnosed along with nine benign lesions. For endoscopic submucosal dissections,en-bloc and R0 resection rates were 100% (n=6/6) and 83% (n=5/6); for endoscopic mucosal resections, they were 92% (n=11/12) and 83%(n=10/12), respectively. Only one patient had procedure-related late perforation that was managed endoscopically. No mortality was encountered.Conclusion: Duodenal endoscopic resections proved successful, safe and feasible methods in a tertiary center. The pathologist’s role is to designatethe accurate diagnosis, related histopathologic parameters and margin status. The gross protocol was found to be essential in evaluating specimenmargins and orientation, as well as in size measurement. We recommend following a standardized approach including gross photography anddigital mapping when handling these specimens, for both diagnostic and data collection purposes.