Safety and feasibility of laparoscopic and endoscopic cooperative surgery for duodenal neoplasm: A retrospective multicenter study

Background and study aims A delayed perforation can often occur after endoscopic treatment for duodenal neoplasms and cause fatality due to leakage of pancreatic and bile juices. We aimed to evaluate the feasibility and safety of laparoscopic and endoscopic cooperative surgery for duodenal neoplasms (D-LECS) in a multicenter retrospective study. Patients and methods The clinical characteristics and surgical outcomes of 206 patients with duodenal neoplasms in whom D-LECS had initially been attempted at one of 14 institutions were retrospectively reviewed. Results Of the 206 patients, 63 (31%), 128 (62%), and 15 patients (7%) had lesions at the bulb, second portion, and third portion of the duodenum, respectively. The rates of en bloc and R0 resections during D-LECS were 96% and 95%, respectively. Intraoperative and delayed perforations occurred in 9 (4.3%) and 5 patients (2.4%), respectively. No recurrent cases were observed in this study. The risks of postoperative complications were surgical duration of ≥3 h. Conclusions The results of the present study revealed that D-LECS was performed with oncological feasibility with technical safety.

Characterization of American Teduglutide Consumers from 2015–2020: A Large Database Study

Objectives The glucagon-like peptide 2 (GLP-2) analog teduglutide (TED) is a novel therapy for intestinal failure that reduces need for parenteral support. Degree of response may correlate to location of surgical anastomoses. TED may worsen heart failure (HF) and gastrointestinal (GI) neoplasms. Using a large database we characterize American patients prescribed TED. Methods The Explorys national database (Cleveland, OH, USA) is an aggregate of de-identified patient data from 26 US healthcare systems. SNOMED classification was used to identify consecutive patients prescribed TED, 2015–2020. Demographics and comorbidities were collected. Preceding surgeries, suspected inciting conditions, and incident symptoms/events post TED were searched using the temporal attributes feature on Explorys. Results Of 72 million patients, 170 are prescribed TED. Age range of majority was 45–69 years. 70% were female, 82% caucasian and 12% African American. 70 used medicare, and 70 private insurance. In 50 patients, initial BMI was > 30, 40 had BMI < 19, and majority had BMI 19–29. 10 had opioid dependence, and 70 tobacco use. 30 started TED with comorbid HF; 10 had prior GI malignancy. Common underlying conditions: bowel obstruction (N = 80), Crohn's (N = 70; 50 fistulizing, 10 abscess-forming), congenital gut malformation (N = 30), mesenteric ischemia (N = 30), and perforation (N = 20). <10 had radiation enteritis, traumatic intestinal injury and intestinal dysmotility. Prior surgeries: 60 had ileostomy, and 40 colostomy. 90 had partial colonic resection and 30 partial excisions of small bowel. Only 10 had jejunal bypass, and <10 esophagojejunostomy, gastrojejunostomy, pancreaticojejunostomy, jejunojejunostomy, ileocolic anastomosis, and small bowel transplant. Common incident symptoms/events: abdominal pain (N = 70), nausea (N = 40), intestinal obstruction (N = 30), stoma complications (N = 20), ≤10 had colon polyps, duodenal neoplasm, biliary disorder, pancreatitis, flatulence, and fluid overload. Conclusions In 26 US centers, TED use is rare and associated with several known indications for intestinal surgery. Most were not underweight, and many were obese at initiation. Serious adverse events appear rare. Increased awareness of TED is needed, but careful risk-benefit analysis is needed prior to prescribing TED in patients with GI neoplasms and HF. Funding Sources None.