S1107 Duodenal Endoscopic Submucosal Dissection in the United States: A Single Center Case Series

Abstract

Introduction: Endoscopic Submucosal Dissection (ESD) is a well-established effective endoscopic technique which facilitates en bloc removal of gastrointestinal epithelial lesions. Duodenal ESD is a relatively novel and rare procedure in the United States (US). Here we report a single-center case series of duodenal ESD in the US. Methods: Patients who received ESD at Memorial Sloan Kettering Cancer Center from June 2018 to May 2022 were reviewed (n=477) and a total of 29 patients who had duodenal ESD were included in this study. Gender, age, American Society of Anesthesiology (ASA) score, type of sedation, type of solution for submucosal lifting agents, procedure time, location of the lesion, en bloc resection rate, R0 (complete) resection rate, presence of scar, adverse events, final pathology, and the length of hospital stay were reviewed. Results: A total of 29 patients had duodenal ESD (6.0%). 13 were female (44.8%), 16 were male (55.2%) and the median age was 68 (range 40 – 79). 25 cases (86.2%) had adenoma, 3 cases (10.3%) had neuroendocrine tumor and 1 had no tumor in the final pathology report. 23 were performed under general anesthesia (79.3%) and 6 with propofol sedation (20.7%). 10 patients (34.5%) were classified ASA Ⅱ and 19 patients (65.5%) were ASA Ⅲ. The location of lesions was 2nd part (15/29, 51.7%), followed by 3rd part (10/29, 34.5%), 1st part and bulb (3/29, 10.3%). En bloc resection was achieved in 14 cases (48.3%) and 3 had post-endoscopic mucosal resection (EMR)/ polypectomy scars (3/14, 21.4%). R0 resection rate was 44.8% (13 cases). Of 15 of piecemeal resections (51.7%), 4 had post-EMR/ polypectomy scars (4/15, 26.7%). En bloc and piecemeal resection rate were not affected by the presence of scars (p=0.35). ORISE was used in 16 cases (55.2%) and Eleview was used in 13 cases (44.8%) as the lifting solution and en bloc resection rate was 50% (8/16) with ORISE cases and 46.2% (6/13) in Eleview cases. Mean procedure time was 119 minutes (range 24 -240). As a complication, no perforations were noted. 1 patient developed post-ESD pancreatitis after the removal of large adenoma involving ampulla. The median length of hospital stay was 2 days (range 0 - 20). (Table) Conclusion: This study demonstrated that the duodenal ESD is safe and feasible in the US. The current task is to increase more skilled endoscopists for ESD procedures. Further studies with a larger population are necessary to investigate safety and efficacy in the US. Table 1. - The Data of Duodenal Endoscopic Submucosal Dissection (ESD), Single-Center Case Series Rate of en bloc or piecemeal resection were not affected by the presence of scars (p=0.35) n % Duodenal ESD cases total 29 Gender Female 13 44.8 Male 16 55.2 Age Median age 68 Sedation type General anesthesia 23 79.3 Propofol sedation 6 20.7 ASA score ASA II 10 34.5 ASA III 19 65.5 Location of the lesions 1st part, bulb 3 10.3 2nd part 15 51.7 2nd and 3rd part 1 3.4 3rd part 10 34.5 En bloc (n) % Lifting solution Eleview 13 44.8 6 46.2 ORISE 16 55.2 8 50 Post-EMR/polypectomy scars Scar positive (n) % Resection type En bloc 14 48.3 3 21.4 Piecemeal 15 51.7 4 26.7 Procedure time Mean time 119min Median time 110min Adverse events after ESD Post-ESD pancreatitis 1 3.4 Final pathology Adenoma 25 86.2 NET 3 10.3 No tumor 1 3.4 R0 resection 13 44.8 Maximum size of resected area Mean of maximum size 28.2mm Length of hospital stay Mean length 2.48days Median length 2days ESD: Endoscopic submucosal dissection ASA: American Society of Anesthesiology EMR: Endoscopic mucosal resection NET: Neuroendocrine tumor