Feasibility study comparing underwater endoscopic mucosal resection and conventional endoscopic mucosal resection for superficial non‐ampullary duodenal epithelial tumor &lt; 20 mm

Background and study aim This study aimed to assess the safety and feasibility of endoscopic submucosal dissection (ESD) using a scissors‐type knife with prophylactic closure using over‐the‐scope clip (OTSC) for superficial non‐ampullary duodenal epithelial tumors (SNADETs). Patients and methods Consecutive patients who underwent ESD for SNADETs >10 mm between January 2009 and July 2019 were retrospectively enrolled. We performed ESD using either a needle‐type knife (Flush Knife‐ESD) or a scissors‐type knife (Clutch Cutter‐ESD). Mucosal defects were prophylactically closed using three methods: conventional clip, laparoscopic closure, or OTSC. Results A total of 84 lesions were resected using the Flush Knife‐ESD and the Clutch Cutter‐ESD (37 and 47 patients, respectively), and conventional clip, laparoscopic closure, and OTSC for mucosal defect closure after ESD were applied in 13, 13, and 56 lesions, respectively. The R0 resection rate was significantly higher in the Clutch Cutter‐ESD than that in the Flush Knife‐ESD (97.9% vs 83.8%, respectively, P = 0.040). The intraoperative perforation rate was significantly lower in the Clutch Cutter‐ESD than in the Flush Knife‐ESD (0% vs 13.5%, respectively, P = 0.014). Complete closure rates of conventional clip, laparoscopic closure, and OTSC were 76.9%, 92.3%, and 98.2%, respectively (P = 0.021); and delayed perforation rates were 15.4%, 7.7%, and 1.8%, respectively (P = 0.092). Conclusions Endoscopic submucosal dissection using a scissors‐type knife with prophylactic OTSC closure is safe and feasible for the low‐invasive treatment of SNADETs.

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of endoscopic submucosal dissection using a scissors‐type knife with prophylactic over‐the‐scope clip closure for superficial non‐ampullary duodenal epithelial tumors

Dohi¹,

Yoshida²,

Naito³

et al. 2020

“…In view of the low successful resection rate by EMR, 6–8 there has been a desire to establish alternative treatment options. Kiguchi et al 23 . reported the efficacy of underwater EMR (UW‐EMR) for treating SNADETs that were under 20 mm in diameter.…”

Section: Discussionmentioning

confidence: 99%

Risk factors of delayed bleeding after endoscopic resection of superficial non‐ampullary duodenal epithelial tumors and prevention by over‐the‐scope and conventional clipping

Ohata

Shimizu

Suzuki

et al. 2020

Objectives This study was aimed to reveal risk factors for delayed bleeding after endoscopic resection (ER) of superficial non‐ampullary duodenal epithelial tumors (SNADETs) and at exploring measures to prevent this complication. Methods A total of 235 consecutive patients with 249 SNADETs who had undergone ER were enrolled in this study. They were divided into two groups: OTSC group, consisting of the initial 114 cases in which the defects were closed only using OTSCs; and OTSC‐c group, consisting of the later 135 cases in which conventional clips were additionally used to cover the inverted submucosa after post‐procedure defect closure using OTSCs. The therapeutic outcomes were then compared between the OTSC and OTSC‐c groups. Results All lesions were successfully resected en‐bloc, and the R0 resection rate was 92.4%. The complete defect closure rate was 90.0% and no delayed perforation occurred when successful defect closure was achieved. The rate of delayed bleeding was significantly higher in the OTSC group than in OTSC‐c group (11.4% vs. 1.5%, P = 0.001). Multivariate logistic regression analyses revealed that tumor location distal to the ampulla (OR 10.0; 95% CI 1.24–81.0, P = 0.03) and use of a DOAC (OR 8.83; 95% CI 1.13–68.7, P = 0.04) were significant independent predictors of delayed bleeding. Propensity score‐matching analysis revealed that additional use of conventional clips was associated with a significantly reduced risk of delayed bleeding (P = 0.003). Conclusions Additional use of conventional clips after prophylactic defect closure using OTSCs appears to be useful to reduce the risk of delayed bleeding after ER of SNADETs. UMIN Clinical Trials (No. 000035478).

“…Submucosal fibrosis results in the requirement for endoscopic submucosal dissection (ESD) which is accompanied by a higher frequency of complications, bleeding and perforation . Recently, underwater endoscopic mucosal resection (UEMR) for smaller lesions has become a treatment of choice …”

Section: Introductionmentioning

confidence: 99%

“…5,6 Recently, underwater endoscopic mucosal resection (UEMR) for smaller lesions has become a treatment of choice. [7][8][9] Endoscopic observation is a non-invasive process in which we can examine the entire lesion. However, we can observe detailed microsurface and microvascular structures using magnified endoscopic examination with image-enhanced endoscopy (IEE-ME).…”

Section: Introductionmentioning

confidence: 99%

How I do it: Endoscopic diagnosis for superficial non‐ampullary duodenal epithelial tumors

Nakayama

Kato

Takatori

et al. 2019

Self Cite

There are no reports on detailed endoscopic diagnosis of superficial non‐ampullary duodenal epithelial tumors (SNADET) except for relatively small case series. Herein, we conducted a prospective observational study to investigate the relationship between endoscopic findings and histopathological diagnosis of SNADET. A total of 163 SNADET diagnosed using magnified endoscopic examination with image‐enhanced endoscopy (IEE‐ME) were prospectively registered in this study. We investigated location, size, macroscopic type, color, and IEE‐ME findings including surface structure (closed‐ or open‐loop) and presence of white opaque substance (WOS) in SNADET. We analyzed association between these findings and histopathological diagnosis of SNADET based on the Vienna classification (VCL) using logistic regression analysis. In univariate analysis, lesion size, superficial structure, and WOS deposition showed statistical significance, and the oral side of the lesion location showed statistical tendency for association with VCL C4/5. In multivariate analysis, lesion size (odds ratio [OR], 2.92; 95% CI, 1.94–4.39; P < 0.05) and negative WOS (OR, 5.59; 95% CI, 1.72–18.1; P < 0.05) were significantly associated with VCL C4/5 lesions. Superficial structures with a closed‐loop pattern on the surface showed statistical tendency for predicting VCL C4/5 lesions (OR, 2.15; 95% CI, 0.86–5.37; P = 0.10). Based on these findings, we concluded that negative WOS by IEE‐ME and lesion size were independent predictors of VCL C4/5 SNADET. These factors may help us to understand of pathophysiology of SNADET and to select appropriate therapeutic strategies.