Clinical Outcomes of Endoscopic Mucosal Resection for Superficial Nonampullary Duodenal Epithelial Tumors

Abstract

Introduction: Background and aims: Recently, the number of endoscopic therapies for superficial nonampullary duodenal epithelial tumors (SNADET) has increased. However, the indication criteria have not yet been clearly determined. In addition, the short-term and long-term outcomes of endoscopic therapy for SNADET are unclear. The aim of this study was to evaluate the efficacy and safety of endoscopic mucosal resection (EMR) for SNADET. Methods: Patients and methods: A total of 77 consecutive patients with 80 nonampullary duodenal epithelial tumors underwent EMR between April 2008 and May 2016. Long-term outcomes were investigated in patients with more than 1 year of follow-up. The basic hospital policy on the indication for EMR of SNADET is lesions that can be removed en bloc by EMR, based on the preoperative endoscope findings regarding tumor location and endoscope maneuverability, as well as tumor size and malignant potential. Endoscopic treatment was performed under conscious sedation in most cases, or under general anesthesia when maneuverability was poor and/or in those who were likely to require ESD. Post-EMR ulcers were completely closed with clips in all cases. Results: Result: The mean tumor size was 8.7 mm (range, 2-25 mm), and the mean procedure time was 25.8 min (range, 2-65). Lesions consisted of 44 adenocarcinomas/high-grade intraepithelial neoplasms (55%) and 36 adenomas/low-grade intraepithelial neoplasms (45%). En bloc resection of 70 lesions (87.5%) was achieved, and R0 resection of 48 lesions (60%) was achieved. There were 5 cases of delayed bleeding after EMR (6.3%), but no perforation occurred. Of the 54 patients who were followed up for more than 1 year, none died from a primary duodenal neoplasm, and there were 2 local recurrences during the 39-month median follow-up period (range, 12-98 months). Two patients with local recurrence were treated endoscopically and did not have further recurrence. Conclusion: Conclusion: If EMR is appropriately performed in accordance with the clinical situation, it is considered to be a very safe and efficacious treatment for SNADET.