ESD versus EMR in non-ampullary superficial duodenal tumors: a systematic review and meta-analysis

Pérez-Cuadrado-Robles, Enrique; Quénéhervé, Lucille; Margos, Walter; Moreels, Tom G.; Yeung, Raymond W.; Piessevaux, Hubert; Coron, Emmanuel; Jouret‐Mourin, Anne; Deprez, Pierre Henri

doi:10.1055/a-0579-9050

Cited by 36 publications

(38 citation statements)

References 29 publications

(127 reference statements)

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“…In a recent large retrospective Japanese study involving 168 patients, the rate of delayed adverse events after duodenal ESD was significantly reduced when the mucosal defect was completely closed, compared with only partial closure or no closure (1.7 % vs. 25 % vs. 15.6 %, respectively, P < 0.01) [115]. These data were confirmed by two more studies where delayed bleeding was effectively prevented by prophylactic endoscopic closure of the defect [18,116]. Recently, closure of the defect by OTS clipping has also been shown to be effective in reducing delayed adverse events after ESD [117].…”

Section: Prevention Of Delayed Adverse Events After Duodenal Endoscopic Resectionmentioning

confidence: 82%

“…Similarly, increasing lesion size was associated with a higher recurrence rate [19,52,55,63,106]. With regard to the techniques originally used to remove the lesion, no significant difference in recurrence rate was observed between EMR versus ESD or EMR versus hybrid ESD [18,81]. After a median follow-up of 6.5 months (2-125), Pérez-Cuadrado-Robles et al [20] showed 5/37 recurrences (14.7 %) after ESD and 17/129 (16.7 %) after EMR (P = 0.788).…”

Section: Prevention Of Delayed Adverse Events After Duodenal Endoscopic Resectionmentioning

confidence: 92%

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Endoscopic management of superficial nonampullary duodenal tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2021

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Main recommendations 1 ESGE recommends that all duodenal adenomas should be considered for endoscopic resection as progression to invasive carcinoma is highly likely.Strong recommendation, low quality evidence. 2 ESGE recommends performance of a colonoscopy, if that has not yet been done, in cases of duodenal adenoma.Strong recommendation, low quality evidence. 3 ESGE recommends the use of the cap-assisted method when the location of the minor and/or major papilla and their relationship to a duodenal adenoma is not clearly established during forward-viewing endoscopy.Strong recommendation, moderate quality evidence. 4 ESGE recommends the routine use of a side-viewing endoscope when a laterally spreading adenoma with extension to the minor and/or major papilla is suspected.Strong recommendation, low quality evidence. 5 ESGE suggests cold snare polypectomy for small (< 6 mm in size) nonmalignant duodenal adenomas.Weak recommendation, low quality evidence. 6 ESGE recommends endoscopic mucosal resection (EMR) as the first-line endoscopic resection technique for nonmalignant large nonampullary duodenal adenomas.Strong recommendation, moderate quality evidence. 7 ESGE recommends that endoscopic submucosal dissection (ESD) for duodenal adenomas is an effective resection technique only in expert hands.Strong recommendation, low quality evidence. 8 ESGE recommends using techniques that minimize adverse events such as immediate or delayed bleeding or perforation. These may include piecemeal resection, defect closure techniques, noncontact hemostasis, and other emerging techniques, and these should be considered on a case-by-case basis.Strong recommendation, low quality evidence. 9 ESGE recommends endoscopic surveillance 3 months after the index treatment. In cases of no recurrence, a further follow-up endoscopy should be done 1 year later. Thereafter, surveillance intervals should be adapted to the lesion site, en bloc resection status, and initial histological result. Strong recommendation, low quality evidence.

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Section: Prevention Of Delayed Adverse Events After Duodenal Endoscopic Resectionmentioning

confidence: 82%

Section: Prevention Of Delayed Adverse Events After Duodenal Endoscopic Resectionmentioning

confidence: 92%

Endoscopic management of superficial nonampullary duodenal tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2021

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“…Published data on duodenal ESD in the West is extremely limited. Pérez-Cuadrado-Robles et al 27 published a metanalysis and systematic review of the current published literature that included 14 studies, but only 2 were from the West. Similar rates of bleeding and perforation were found in the East and West.…”

Section: Endoscopic Submucosal Dissection In Duodenummentioning

confidence: 99%

Endoscopic submucosal dissection in the West

Podboy

Friedland

2019

Int J Gastrointest Interv

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Endoscopic resection has emerged as the first line therapy for pre-malignant conditions throughout the gastrointestinal (GI) tract. Resection techniques have evolved from forceps avulsion and snare polypectomy to endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). While ESD was originally developed in Japan for resection of early gastric neoplasia, its use in the East has expanded rapidly to all types of superficial neoplasia throughout the GI tract. Despite the widespread use of ESD in the East, Western adoption of the ESD technique has been lukewarm. The hesitancy to adopt ESD is multifactorial, likely secondary to concern about the increased risk of complications, procedure duration and reimbursement, as well as the long learning curve of ESD. Despite this initial hesitancy, preliminary reports of the use of ESD for the resection of superficial neoplastic lesions in the West have been encouraging. The aim of this review is to highlight the current use of ESD for superficial neoplastic lesions throughout the GI tract in the West.

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“…A 2018 meta-analysis included 14 studies to compare duodenal ESD versus EMR for a total of 784 nonampullary superficial duodenal tumors with the main outcome measure of including en bloc resection. 5 It is worth while to note that only 2 of these studies 5,6 were performed outside of Asia. Although ESD provided a higher complete resection rate (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.06-2.5; P Z .03), there was an increased risk of intraoperative perforations (risk difference, 0.12; 95% confidence interval, 0.04-0.20; P Z .002) and emergent surgery for delayed perforations.…”

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confidence: 99%

“…Specifically, there were 41 out of 238 (17.2%) ESD versus 8 out of 536 (1.49%) EMR intraoperative perforations and 8 out of 236 (3.39%) ESD versus 2 out of 536 (0.37%) EMR delayed perforations. 5 The meta-analysis concluded that given the higher perforation rates, further prospective or controlled studies were needed before duodenal ESDs could be conclusively supported.…”

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confidence: 99%