Efficacy of Underwater Endoscopic Mucosal Resection for Superficial Non-Ampullary Duodenal Epithelial Tumor
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background/Aims: Endoscopic resection (ER) for superficial non-ampullary duodenal epithelial tumors (SNADETs) is challenging. Conventional endoscopic mucosal resection (CEMR) is also problematic due to the anatomical features of the duodenum. Wecompared the safety and efficacy of underwater endoscopic mucosal resection (UEMR) with those of CEMR through a retrospectiveanalysis. Methods: Altogether, 44 consecutive patients with 46 SNADETs underwent ER (18 CEMR cases and 28 UEMR cases) betweenJanuary 2016 and October 2019. We investigated the proportions of en bloc resection, R0 resection, complications, resection time,and total procedure time and compared the outcomes of patients from the CEMR group with those of patients from the UEMRgroup. Results: The median tumor size was 8.0 mm (range, 2.0–20.0 mm). The UEMR group showed a higher proportion of en blocresection (96.4% vs. 72.2%, p<0.05) and significantly lower median resection time and total procedure time (4 min vs. 9.5 min,p<0.05 and 13 min vs. 19 min, p<0.05; respectively) than the CEMR group. No complications were observed. However, two patientstreated with piecemeal resection in the CEMR group had residual tumors. Conclusions: UEMR is a feasible therapeutic option for SNADETs. It can be recommended as a standard treatment.
Abstract
Background/Aims: Endoscopic resection (ER) for superficial non-ampullary duodenal epithelial tumors (SNADETs) is challenging. Conventional endoscopic mucosal resection (CEMR) is also problematic due to the anatomical features of the duodenum. Wecompared the safety and efficacy of underwater endoscopic mucosal resection (UEMR) with those of CEMR through a retrospectiveanalysis. Methods: Altogether, 44 consecutive patients with 46 SNADETs underwent ER (18 CEMR cases and 28 UEMR cases) betweenJanuary 2016 and October 2019. We investigated the proportions of en bloc resection, R0 resection, complications, resection time,and total procedure time and compared the outcomes of patients from the CEMR group with those of patients from the UEMRgroup. Results: The median tumor size was 8.0 mm (range, 2.0–20.0 mm). The UEMR group showed a higher proportion of en blocresection (96.4% vs. 72.2%, p<0.05) and significantly lower median resection time and total procedure time (4 min vs. 9.5 min,p<0.05 and 13 min vs. 19 min, p<0.05; respectively) than the CEMR group. No complications were observed. However, two patientstreated with piecemeal resection in the CEMR group had residual tumors. Conclusions: UEMR is a feasible therapeutic option for SNADETs. It can be recommended as a standard treatment.
참고문헌 (26)
- "Dtsch Med Wochenschr", 1984, 1183~1186
- Jepsen JM, "Prospective study of prevalence and endoscopic and histopathologic characteristics of duodenal polyps in patients submitted to upper endoscopy", Scand J Gastroenterol, 29, pp.483~487 (1994)
- Murray MA, "Sporadic duodenal adenoma is associated with colorectal neoplasia", Gut, 53, pp.261~265 (2004)
- Jung SH, "Evaluation of non-ampullary duodenal polyps : comparison of non-neoplastic and neoplastic lesions", World J Gastroenterol, 16, pp.5474~5480 (2010)
- Goda K, "Endoscopic diagnosis of superficial non-ampullary duodenal epithelial tumors in Japan : multicenter case series", Dig Endosc, 26(Suppl 2), pp.23~29 (2014)
- Seifert E, "Adenoma and carcinoma of the duodenum and papilla of Vater : a clinicopathologic study", Am J Gastroenterol, 87, pp.37~42 (1992)
- Okada K, "Sporadic nonampullary duodenal adenoma in the natural history of duodenal cancer : a study of follow-up surveillance", Am J Gastroenterol, 106, pp.357~364 (2011)
- Asbun HJ, "Management of duodenal polyps in the era of maximal interventional endoscopy and minimally invasive surgery : a surgical perspective", Gastrointest Endosc, 84, pp.697~699 (2016)
- Friedrich-Rust M, "Early-stage small-bowel adenocarcinoma : a review of local endoscopic therapy", Endoscopy, 37, pp.755~759 (2005)
- Nonaka S, "Clinical outcome of endoscopic resection for nonampullary duodenal tumors", Endoscopy, 47, pp.129~135 (2015)
- Apel D, "Follow-up after endoscopic snare resection of duodenal adenomas", Endoscopy, 37, pp.444~448 (2005)
- Alexander S, "EMR of large, sessile, sporadic nonampullary duodenal adenomas : technical aspects and long-term outcome(with videos)", Gastrointest Endosc, 69, pp.66~73 (2009)
- Maruoka D, "Clinical outcomes of endoscopic resection for nonampullary duodenal high-grade dysplasia and intramucosal carcinoma", Endoscopy, 45, pp.138~141 (2013)
- Klein A, "Endoscopic mucosal resection of large and giant lateral spreading lesions of the duodenum : success, adverse events, and long-term outcomes", Gastrointest Endosc, 84, pp.688~696 (2016)
- Jung JH, "Endoscopic submucosal dissection for sessile, nonampullary duodenal adenomas", Endoscopy, 45, pp.133~135 (2013)
- Matsumoto S, "Endoscopic submucosal dissection for duodenal tumors : a single-center experience", Endoscopy, 45, pp.136~137 (2013)
- Hoteya S, "Endoscopic submucosal dissection for nonampullary large superficial adenocarcinoma", adenoma of the duodenum : feasibility and long-term outcomes, 2013, pp.1, 2~7
- Inoue T, "Delayed perforation : a hazardous complication of endoscopic resection for non-ampullary duodenal neoplasm", Dig Endosc, 26, pp.220~227 (2014)
- Binmoeller KF, ""Underwater"EMR of sporadic laterally spreading nonampullary duodenal adenomas(with video)", Gastrointest Endosc, 78, pp.496~502 (2013)
- Yamasaki Y, "Underwater endoscopic mucosal resection for superficial nonampullary duodenal adenomas", Endoscopy, 50, pp.154~158 (2018)
- Dixon MF, "Gastrointestinal epithelial neoplasia : Vienna revisited", Gut, 51, pp.130~131 (2002)
- Kinoshita S, "Accuracy of biopsy for the preoperative diagnosis of superficial nonampullary duodenal adenocarcinoma", Gastrointest Endosc, 86, pp.329~332 (2017)
- Oka S, "Local recurrence after endoscopic resection for large colorectal neoplasia : a multicenter prospective study in Japan", Am J Gastroenterol, 110, pp.697~707 (2015)
- Hoteya S, "Delayed bleeding after endoscopic submucosal dissection for non-ampullary superficial duodenal neoplasias might be prevented by prophylactic endoscopic closure : analysis of risk factors", Dig Endosc, 27, pp.323~330 (2015)
- Yahagi N, "Outcomes of endoscopic resection for superficial duodenal epithelial neoplasia", Gastrointest Endosc, 88, pp.676~682 (2018)
- Kiguchi Y, "Feasibility study comparing underwater endoscopic mucosal resection and conventional endoscopic mucosal resection for superficial non-ampullary duodenal epithelial tumor < 20 mm", Dig Endosc, 32, pp.753~760 (2020)