Appropriate endoscopic treatment selection and surveillance for superficial non-ampullary duodenal epithelial tumors

Abstract

Objectives

Superficial nonampullary duodenal epithelial tumors (SNADETs) have become frequently detected and referred for endoscopic resection (ER). However, optimal treatment methods and long-term outcomes after ER of SNADETs have not been fully elucidated. We aimed to clarify them by analyzing our large cohort of patients with SNADETs.

Materials and methods

We enrolled 190 consecutive tumors from 189 patients undergoing ER between January 2004 and September 2019. Cases were stratified into endoscopic submucosal dissection (ESD), conventional endoscopic mucosal resection, (CEMR) and underwater endoscopic mucosal resection (UEMR). Baseline characteristics and short-term outcomes were compared between the groups. Long-term outcomes were also investigated with a median follow-up of 36 months.

Results

ESD significantly exceeded CEMR (96.4% vs. 52.9%; p = .0026) and UEMR (96.4% vs. 50.0%; p = .0008) in complete resection rates for 11- to 20-mm lesions; the differences were not significant for lesions ≤10 mm. Local recurrence only occurred in patients with an incomplete resection. Only patients with submucosal invasion died from the primary neoplasms. The 3- and 5-year disease-free survivals were 91.3% and 83.5%.

Conclusions

While tumors ≤10 mm seem to be good indications for endoscopic mucosal resection, ESD should be considered for larger tumors to better achieve complete resection. Patients with submucosal invasive carcinomas have a great risk of cancer death. Therefore, a close follow-up and an additional treatment are desirable.

Keywords:

• Duodenal neoplasm
• endoscopic mucosal resection
• endoscopic submucosal dissection
• short-term outcome
• long-term outcome

Ethical approval

The research ethics committee in our hospital approved this research (Approval number: D1602024) in March 2016.

Informed consent

All patients enrolled in this study provided written informed consent before undergoing endoscopic treatment.

Author contributions

Hirasawa K contributed to conception and design. Hirasawa K, Ozeki Y, Sawada A, Sato C, Ikeda R, Nishio M, Fukuchi T, Kobayashi R, and Makazu M contributed to acquisition of data. Hirasawa K contributed to analysis and interpretation of data. Hirasawa K contributed to drafting of the article. Hirasawa K and Maeda S contributed to critical revision of the article. Hirasawa K and Taguri M contributed to statistical analysis. Hirasawa K and Maeda S approved critical revision of the article for important intellectual content and the final draft of the article. All authors listed have contributed substantially to the design, data collection and analysis, and editing of the manuscript.

Disclosure statement

The authors have no conflict of interest.