Nonampullary Duodenal Neoplasms Can Be Safely and Less Invasively Removed with Clip-Guided Local Duodenectomy

Background: For certain nonampullary duodenal neoplasms, a straightforward treatment approach is local duodenectomy and primary closure. A safe primary duodenal closure requires curability and minimization of the resection area. However, finding the proper resection line from the serosal side can be challenging. To improve the safety and ease of local duodenectomy, we created a clip-guided local duodenectomy. To validate the safety of this procedure, we conducted retrospective observational research. Methods: During the procedure, four endoscopic metal clips were placed on the margin surrounding the tumor three days prior to surgery. The clips are then used to determine the extent of the tumor during X-ray imaging; an incision is made to the duodenum just outside of the clips; a full-thickness resection of the duodenum is performed using the clips as guides to demarcate the tumor; and the incision is closed transversely using a Gambee suture. Between March 2010 and February 2020, one surgical center evaluated the clinicopathological data and surgical outcomes of patients who underwent local duodenectomy under clip guidance. Results: There were eighteen patients in total. Adenoma (11 patients), adenocarcinoma (6 patients), and GIST (1 patient) were pathologically diagnosed. The primary location of the tumors was in the second part of the duodenum, accounting for 66% of the total tumor size, with a mean size of 18 ± 6 mm. Primary sutures were used for each patient to repair the duodenal defect. The mean operation time was 191 minutes, while the mean blood loss was 79 millilitres. There was a 22% morbidity rate, and all complications were Grade II complications according to the Clavien‒Dindo system. There was no evidence of anastomotic leakage or stenosis. All six of the adenocarcinoma patients had pT1a disease, and there was no evidence of postoperative recurrence. The overall 1-year survival rate was 100%, with no recurrences. Conclusion: Clip-guided local duodenectomy is a safe and effective way to remove nonampullary duodenal neoplasms such as duodenal adenoma, GIST, and early adenocarcinoma with minimal damage to the surrounding tissue.