Endoscopic Submucosal Dissection and Endoscopic Mucosal Resection for Non-Ampullary Superficial Duodenal Tumor

Abstract

Background: Endoscopic submucosal resection (ESD) and endoscopic mucosal resection (EMR) are well established as curable and safety procedures for treating superficial tumors of the stomach, esophagus and colon. However, a majority of endoscopic resection strategies for non-ampullary superficial duodenal tumors (NASDTs) remains undefined. The aim of this study was to clarify which was the right method for NASDT treatment - EMR or ESD. Summary: We analyzed 129 consecutive endoscopic resection (74 ESD and 55 EMR) procedures performed with NADSTs and divided the ESD group into 49 large ESD groups (more than 20 mm in diameter) and 25 small ESD groups (less than 20 mm in diameter). With respect to the technical outcomes of EMR/ESD for small size NASDTs, EMR was safer than ESD, but its nature of curability was inferior to that of ESD. The rates of complication such as perforation or delayed bleeding were significantly higher in both ESD groups than in the EMR group. However, the prophylactic endoscopic closure of large mucosal defects after ESD was useful for resolving those complications. The limitations of our study were involvement of a single-center, limited sample size, short follow-up duration and the retrospective design, which may have introduced selection bias. However, the present findings suggest that adequate endoscopic treatment strategy for NASDTs can lead to favorable outcomes and an excellent prognosis. Key Message: It is necessary to select EMR or ESD adequately for R0 resection of small NASDTs, according to their size and location. For large NASDTs, duodenal ESD with essential management is feasible and useful as a therapeutic procedure.

Treatment Outcomes of Endoscopic Submucosal Dissection for Adenocarcinoma Originating from Long-Segment Barrett’s Esophagus versus Short-Segment Barrett’s Esophagus

“…To reduce the risk of recurrence, en bloc and complete resection of tumor components is important. ESD is a therapeutic procedure that enables en bloc resection irrespective of lesion size and is superior to EMR in terms of en bloc resection rate and curability [2,27]. An en bloc specimen allows accurate pathological evaluation of risk factors for lymph node metastasis and recurrence and is therefore expected to improve treatment outcomes.…”

Current Status of Endoscopic Resection for Superficial Nonampullary Duodenal Epithelial Tumors

“…ESD, which was developed in Japan, yielded a low recurrence rate (0%) for SNADETs regardless of lesion size [13-17], but this technique was associated with a high incidence of adverse events, including morbid complications (e.g., delayed bleeding, intraoperative perforation, and delayed perforation rates of 0–22%, 19–35%, and 3–20%, respectively) [13-18]. The indication size is ≥15–20 mm, and it is difficult to remove a lesion of this size en bloc using EMR or UEMR Table 1.…”

Clinicopathological Features and Magnifying Chromoendoscopic Findings of Non-Ampullary Duodenal Epithelial Tumors

“…While several studies have shown the efficacy of endoscopic treatment for NADETs, the procedure is complicated by a high incidence of adverse events due to anatomical reasons [1, 4-7]. In addition, tissue sampling from NADETs through endoscopic forceps biopsy induces fibrosis, which results in difficulty on subsequent endoscopic treatment [8, 9].…”