Duodenal mucosal autotransplantation.

BACKGROUND AND AIMS: Closure of large defects and postresection strictures can be challenging to manage after endoscopic mucosal resection (EMR) of large duodenal lesions. Duodenal mucosal autotransplantation (DAT) may offer a new strategy for defect closure and stricture prevention in patients that undergo resection of large lesions in the duodenum.

METHODS

A 57-year-old female underwent piecemeal EMR of a duodenal adenoma involving 60% of the luminal circumference. A mucosal autograft (2 x 2 cm) was harvested from adjacent duodenum using standard EMR technique and fixed to the resection bed using helical tacks and hemostatic clips. This resulted in complete defect closure without luminal compromise.

RESULTS

On follow-up EGD at 6 weeks, we noted graft incorporation, intact helix tacks and clips, and no evidence of duodenal stricture formation. The recipient site showed healthy mucosa, confirmed by biopsy, and the donor site healed well. Histopathology revealed viable duodenal mucosa with submucosal fibrosis. EGD at 6 months revealed well-healed donor and recipient sites, without evidence of stricture formation.

CONCLUSIONS

DAT is a feasible technique for closure of large duodenal defects and may reduce stricture risk. Further studies are warranted to evaluate long-term outcomes and broader applicability of this approach.