TECHNICAL MODIFICATIONS AND SHORT-TERM OUTCOMES OF D-LECS FOR DUODENAL EPITHELIAL TUMORS hharada@med.kitasato-u.ac.jp

PE078

TECHNICAL MODIFICATIONS AND SHORT-TERM OUTCOMES OF D-LECS FOR DUODENAL EPITHELIAL TUMORS

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Keishi Yamashita keishi23@med.kitasato-u.ac.jp Kitasato University School of Medicine Research and Development Center for New Medical Frontiers Sagamihara Japan

Chika Kusano c-kusano@kitasato-u.ac.jp Kitasato University School of Medicine Gastroenterology Sagamihara Japan

Naoki Hiki nhiki@med.kitasato-u.ac.jp Kitasato University School of Medicine Upper Gastrointestinal Surgery Sagamihara Japan

 

Japan

Poster Exhibition only

Laparoscopy and Endoscopy Cooperative Surgery for Duodenal Tumors (D-LECS) has been reimbursed in Japan since 2020 and is increasingly adopted as a treatment option for superficial non-ampullary duodenal epithelial tumors (SNADETs). Endoscopic submucosal dissection (ESD) for SNADETs, however, carries a high perforation rate of 15.5%, including delayed perforations, which may lead to severe complications. At our institution, D-LECS is performed for non-ampullary SNADETs deemed resectable by en bloc ESD, incorporating original technical modifications to improve safety. This study reports our specific techniques and short-term outcomes.

We retrospectively reviewed patients who underwent D-LECS at our institution between August 2021 and June 2025. To improve endoscopic maneuverability, extensive Kocher mobilization was performed to straighten the duodenum, followed by underwater ESD using the gel immersion method for better visualization and hemostasis. The mucosal defect was closed with full-thickness horizontal mattress sutures to create an everting closure, preventing postoperative perforation and stricture. In addition, the duodenum was fixed to the retroperitoneum to avoid postoperative dysmotility.

A total of 27 patients underwent D-LECS (bulb: 3, second portion: 18, third portion: 6). Median operative time was 284 minutes (176–506), ESD time 47 minutes (15–238), and blood loss 6 g (0–320). Median tumor size was 22 mm (10–40); pathology revealed 13 adenocarcinomas and 14 adenomas. Median postoperative hospital stay was 8 days (6–19). One case (3.7%) of delayed perforation occurred in the 7th patient.

Our modified D-LECS technique effectively avoided delayed perforation and enabled safe resection of SNADETs, demonstrating favorable short-term outcomes.