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Background and study aims Endoscopic submucosal dissection (ESD) for duodenal tumors results in a high delayed perforation rate due to the thinness of the duodenal wall. In most cases with perforation after duodenal ESD, additional surgery is needed due to severe peritonitis. A newly developed procedure, laparoscopic endoscopic cooperative surgery for duodenal tumors (D-LECS), may help to avoid perforation after ESD. In our institution, patients with superficial non-ampullary duodenal epithelial tumors (SNADET) smaller than 50 mm which could not have en-bloc resection by endoscopic mucosal resection were treated with D-LECS. After a laparoscopic exposure of anterior duodenal wall of second portion, ESD was performed. Laparoscopic suturing from the serosal side of ESD site was performed for reinforcement. There were neither postoperative leakage nor other complications. Therefore, D-LECS can be performed safely and prevent perforation after ESD for SNADET. D-LECS could be selected as a treatment for SNADET which can be cured by ESD.

PURPOSE: To evaluate the biocompatibility and effectiveness of porcine SIS (small intestinal submucosa), when used as a patch to repair a defect on the anterior duodenal wall. METHODS: The experimental study was performed in 8 dogs. A segment of the anterior duodenal wall was removed and the defect was repaired with a patch of porcine intestinal submucosa. On the 120th post operative day the animals were sacrified and the segment of duodenum containing the patch was removed to a macroscopic and microscopic evaluation. RESULTS: There was no infection, suture dehiscence or fistula. The microscopic evaluation showed complete re-epithelization in 75% of the cases, with moderate fibroblastic proliferation in 87, 5% of the cases. CONCLUSION: The porcine SIS used as a patch acts as a tissue substitute for repairing induced lesions in duodenal wall of dogs.