Motohiko Kato1, Yoji Takeuchi2, Shu Hoteya3, Tsuneo Oyama4, Satoru Nonaka5, Shoichi Yoshimizu6, Naomi Kakushima7, Ken Ohata8, Hironori Yamamoto9, Yuko Hara10, Hisashi Doyama11, Osamu Dohi12, Yasushi Yamasaki13, Hiroya Ueyama14, Kengo Takimoto15, Koichi Kurahara16, Tomoaki Tashima17, Nobutsugu Abe18, Atsushi Nakayama1, Ichiro Oda5, Naohisa Yahagi1. 1. Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan. 2. Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan. 3. Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan. 4. Department of Endoscopy, Saku Central Hospital Advanced Care Center, Nagano, Japan. 5. Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan. 6. Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan. 7. Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan. 8. Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan. 9. Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan. 10. Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan. 11. Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan. 12. Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan. 13. Department of Gastroenterology, Okayama University Hospital, Okayama, Japan. 14. Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan. 15. Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan. 16. Division of Gastroenterology, Matsuyama Red Cross Hospital, Matsuyama, Japan. 17. Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan. 18. Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan.
Abstract
BACKGROUND: Data on endoscopic resection (ER) for superficial duodenal epithelial tumors (SDETs) are insufficient owing to their rarity. There are two main ER techniques for SDETs: endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). In addition, modified EMR techniques, such as underwater EMR (UEMR) and cold polypectomy, are becoming popular. We conducted a large-scale retrospective multicenter study to clarify the detailed outcomes of duodenal ER. METHODS: Patients with SDETs who underwent ER at 18 institutions from January 2008 to December 2018 were included. The rates of en bloc resection and delayed adverse events (AEs; defined as delayed bleeding or perforation) were analyzed. Local recurrence was analyzed using the Kaplan-Meier method. RESULTS: In total, 3107 patients (including 1017 undergoing ESD) were included. En bloc resection rates were 79.1 %, 78.6 %, 86.8 %, and 94.8 %, and delayed AE rates were 0.5 %, 2.2 %, 2.8 %, and 6.8 % for cold polypectomy, UEMR, EMR and ESD, respectively. The delayed AE rate was significantly higher in the ESD group than in non-ESD groups for lesions < 19 mm (7.4 % vs. 1.9 %; P < 0.001), but not for lesions > 20 mm (6.1 % vs. 7.1 %; P = 0.64). The local recurrence rate was significantly lower in the ESD group than in the non-ESD groups (P < 0.001). Furthermore, for lesions > 30 mm, the cumulative local recurrence rate at 2 years was 22.6 % in the non-ESD groups compared with only 1.6 % in the ESD group (P < 0.001). CONCLUSIONS: ER outcomes for SDETs were generally acceptable. ESD by highly experienced endoscopists might be an option for very large SDETs. Thieme. All rights reserved.
BACKGROUND: Data on endoscopic resection (ER) for superficial duodenal epithelial tumors (SDETs) are insufficient owing to their rarity. There are two main ER techniques for SDETs: endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). In addition, modified EMR techniques, such as underwater EMR (UEMR) and cold polypectomy, are becoming popular. We conducted a large-scale retrospective multicenter study to clarify the detailed outcomes of duodenal ER. METHODS: Patients with SDETs who underwent ER at 18 institutions from January 2008 to December 2018 were included. The rates of en bloc resection and delayed adverse events (AEs; defined as delayed bleeding or perforation) were analyzed. Local recurrence was analyzed using the Kaplan-Meier method. RESULTS: In total, 3107 patients (including 1017 undergoing ESD) were included. En bloc resection rates were 79.1 %, 78.6 %, 86.8 %, and 94.8 %, and delayed AE rates were 0.5 %, 2.2 %, 2.8 %, and 6.8 % for cold polypectomy, UEMR, EMR and ESD, respectively. The delayed AE rate was significantly higher in the ESD group than in non-ESD groups for lesions < 19 mm (7.4 % vs. 1.9 %; P < 0.001), but not for lesions > 20 mm (6.1 % vs. 7.1 %; P = 0.64). The local recurrence rate was significantly lower in the ESD group than in the non-ESD groups (P < 0.001). Furthermore, for lesions > 30 mm, the cumulative local recurrence rate at 2 years was 22.6 % in the non-ESD groups compared with only 1.6 % in the ESD group (P < 0.001). CONCLUSIONS: ER outcomes for SDETs were generally acceptable. ESD by highly experienced endoscopists might be an option for very large SDETs. Thieme. All rights reserved.