Mo1611 Double Balloon-Assisted Deep Enteroscopy for the Study of Patients Suspected of Complicated Celiac Disease

Abstract

the indication for duodenal ESD is highly controversial. EMR with a cap-fitted panendoscope (EMR-C) is known as an effective treatment for esophageal tumors in particular. Recently, we have performed EMR-C as therapy for the superficial epithelial type of sporadic non-ampullary duodenal adenoma/carcinoma (SNADA) in our establishment. However, efficacy for duodenal tumors has not yet been reported. In this study, we assessed the efficacy of EMR-C for the superficial epithelial type of SNADA. Methods: We retrospectively evaluated 74 patients with SNADA who underwent endoscopic resection between May 2004 and October 2014 at our establishment. In addition, we assessed and compared the incidence rate of complications and frequency rate of en bloc resection according to the macroscopic appearance of the lesions and the methods of mucosal resection, especially of the superficial epithelial type of SNADA, between EMR-C and EMR. Results: The mean age of the patients was 63.7 12.0 years and 52 were male. Seventy-nine SNADA lesions were resected. The final pathological diagnoses, low-grade dysplasia, highgrade dysplasia, and intramucosal carcinoma were 21, 27, and 31, respectively. The mean size of the lesions was 10.5 5.8 mm. The numbers of macroscopic appearance of types Ip, Is, Is + IIa, IIa, IIa + IIc, and IIc according to the Paris endoscopic classification were 5, 9, 3, 27, 21, and 14, respectively. The numbers of lesions resected by polypectomy, EMR, EMR-C, strip biopsy, and ESD were 1, 33, 25, 9, and 11, respectively. The perforation rate with EMR and EMR-C were significantly lower than that with ESD (0% and 4.0% vs. 27.3%; p Z 0.002 and 0.041, chi-square test). For superficial epithelial lesions, the rate of en bloc resection in EMR-C was 96.0% (24 in 25 lesions), which was significantly higher than that in EMR (vs. 68.4%, 13 in 19 lesions; p Z 0.0139, chi-square test). Furthermore, no significant difference in the mean size of the resected superficial epithelial type of SNADA was observed between EMR-C and EMR (7.6 3.2 mm vs. 8.7 4.3 mm; p Z 0.361, MannWhitney U test). Conclusions: EMR-C had a significant higher rate of en bloc resection of the superficial epithelial type of SNADA than EMR. EMR-C is a safe and effective treatment of SNADA, especially of the superficial epithelial type.