Background and Aim
Underwater endoscopic mucosal resection (U‐EMR) has been attracting much attention as treatment for patients with nonampullary duodenal epithelial tumors (NADETs). We aim to compare treatment outcomes, including submucosal resectability, between patients undergoing U‐EMR and conventional endoscopic mucosal resection (C‐EMR) for NADET.
Methods
We conducted a retrospective review of 38 patients with NADET treated by U‐EMR or C‐EMR. In the resected specimens, we measured the horizontal length, the vertical distance from the muscularis mucosa to the margin at the deepest site, and the overall submucosal area. The submucosal index (SMI) was defined as the overall submucosal area divided by the largest horizontal length. These values and other treatment outcomes were compared between NADETs resected by U‐EMR and C‐EMR.
Results
The median size of lesions was 7 mm with a range of 3–13 mm. Although the incidence of adverse events and the rates of en bloc and R0 resection were not different in the two groups, the median procedure time was significantly shorter in the U‐EMR group (11 min vs 13 min; P = 0.045). The median submucosal depth at the deepest site (1.22 mm vs 1.08 mm; P = 0.38) and the median SMI (0.44 vs 0.41; P = 0.42) were not different between groups.
Conclusions
The resectability between NADETs treated by U‐EMR and C‐EMR was comparable. These results, together with the shorter procedure time required for U‐EMR, suggest that U‐EMR may have the potential to be the first choice for small to medium‐sized NADET.
Background and Aim
The aim of this study was to elucidate the continuous use of antithrombotic medications during the peri‐colorectal endoscopic submucosal dissection (ESD) period.
Methods
This study included 468 patients with colorectal epithelial neoplasms treated by ESD, consisting of 82 under antithrombotic medications and 386 patients without the medications. Among patients taking antithrombotic medications, antithrombotic agents were continued during the peri‐ESD period. Clinical characteristics and adverse events were compared after propensity score matching.
Results
Before and after propensity score matching, post‐colorectal ESD bleeding rate was higher in patients continuing antithrombotic medications (19.5% and 21.6%, respectively) than in those not taking antithrombotic medications (2.9% and 5.4%, respectively). In the Cox regression analysis, continuation of antithrombotic medications was associated with post‐ESD bleeding risk (hazard ratio, 3.73; 95% confidence interval, 1.2–11.6; P < 0.05) compared with patients without antithrombotic therapy. All patients who experienced post‐ESD bleeding were successfully treated by endoscopic hemostasis procedure or conservative therapy.
Conclusions
Continuation of antithrombotic medications during the peri‐colorectal ESD period increases the risk of bleeding. However, the continuation may be acceptable under careful monitoring for post‐ESD bleeding.
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