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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Aug 15, 2020; 12(8): 918-930
Published online Aug 15, 2020. doi: 10.4251/wjgo.v12.i8.918
Endoscopic mucosal resection vs endoscopic submucosal dissection for superficial non-ampullary duodenal tumors
Mitsuru Esaki, Kazuhiro Haraguchi, Kazuya Akahoshi, Naru Tomoeda, Akira Aso, Soichi Itaba, Haruei Ogino, Yusuke Kitagawa, Hiroyuki Fujii, Kazuhiko Nakamura, Masaru Kubokawa, Naohiko Harada, Yosuke Minoda, Sho Suzuki, Eikichi Ihara, Yoshihiro Ogawa
Mitsuru Esaki, Haruei Ogino, Yosuke Minoda, Eikichi Ihara, Yoshihiro Ogawa, Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 8128582, Japan
Mitsuru Esaki, Sho Suzuki, Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo 1738610, Japan
Kazuhiro Haraguchi, Department of Gastroenterology, Hara-Sanshin Hospital, Fukuoka 8120033, Japan
Kazuya Akahoshi, Masaru Kubokawa, Department of Gastroenterology, Aso Iizuka Hospital, Iizuka 8208502, Japan
Naru Tomoeda, Naohiko Harada, Department of Gastroenterology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka 8108564, Japan
Akira Aso, Department of Gastroenterology, Kitakyushu Municipal Medical Center, Kitakyushu 8020077, Japan
Soichi Itaba, Department of Gastroenterology, Kyushu Rosai Hospital, Kitakyushu 8000296, Japan
Yusuke Kitagawa, Department of Internal Medicine, Saiseikai Fukuoka General Hospital, Fukuoka 8100001, Japan
Hiroyuki Fujii, Kazuhiko Nakamura, Department of Gastroenterology and Hepatology, National Hospital Organization Fukuokahigashi Medical Center, Koga 81103195, Japan
Eikichi Ihara, Department of Gastroenterology and Metabolism, Graduate School of Medicine Sciences, Kyushu University, Fukuoka 8128582, Japan
Author contributions: Esaki M, Minoda Y, Ogino H, and Ihara E designed the research; Esaki M drafted and revised the article for important intellectual content; Haraguchi K, Akahoshi K, Tomoeda N, Aso A, Itaba S, Kitagawa Y, Fujii H, Nakamura K, Kubokawa M, and Harada N analyzed and interpreted the data; Suzuki S critically revised the manuscript for important intellectual content; Ogawa Y supervised the whole process; all authors have read and approved the final version to be published.
Institutional review board statement: This study was conducted according to the ethical principles of the Declaration of Helsinki, and each institution’s review board and ethical committee approved the study’s protocol.
Informed consent statement: Written informed consent for performing endoscopic resection was obtained from each patient before treatment in accordance with the protocol at each institution. Consent for using the data in this study was waived because of the retrospective nature of the study.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: The datasets used and/or analyzed during the current study are available from corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Eikichi Ihara, MD, PhD, Associate Professor, Department of Gastroenterology and Metabolism, Graduate School of Medicine Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 8128582, Japan. eikichi@intmed3.med.kyushu-u.ac.jp
Received: January 1, 2020
Peer-review started: January 1, 2020
First decision: April 18, 2020
Revised: July 3, 2020
Accepted: July 19, 2020
Article in press: July 19, 2020
Published online: August 15, 2020
BACKGROUND
The selection of endoscopic treatments for superficial non-ampullary duodenal epithelial tumors (SNADETs) is controversial.
AIM
To compare the efficacy and safety of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) for SNADETs.
METHODS
We retrospectively analyzed the data of patients with SNADETs from a database of endoscopic treatment for SNADETs, which included eight hospitals in Fukuoka, Japan, between April 2001 and October 2017. A total of 142 patients with SNADETs treated with EMR or ESD were analyzed. Propensity score matching was performed to adjust for the differences in the patient characteristics between the two groups. We analyzed the treatment outcomes, including the rates of en bloc/complete resection, procedure time, adverse event rate, hospital stay, and local or metastatic recurrence.
RESULTS
Twenty-eight pairs of patients were created. The characteristics of patients between the two groups were similar after matching. The EMR group had a significantly shorter procedure time and hospital stay than those of the ESD group [median procedure time (interquartile range): 6 (3-10.75) min vs 87.5 (68.5-136.5) min, P < 0.001, hospital stay: 8 (6-10.75) d vs 11 (8.25-14.75) d, P = 0.006]. Other outcomes were not significantly different between the two groups (en bloc resection rate: 82.1% vs 92.9%, P = 0.42; complete resection rate: 71.4% vs 89.3%, P = 0.18; and adverse event rate: 3.6% vs 17.9%, P = 0.19, local recurrence rate: 3.6% vs 0%, P = 1; metastatic recurrence rate: 0% in both). Only one patient in the ESD group underwent emergency surgery owing to intraoperative perforation.
CONCLUSION
EMR has significantly shorter procedure time and hospital stay than ESD, and provides acceptable curability and safety compared to ESD. Accordingly, EMR for SNADETs is associated with lower medical costs.
Core tip: The standard treatment for superficial non-ampullary duodenal epithelial tumors (SNADETs) is controversial. We conducted a multi-center retrospective study, which aimed to compare the treatment outcomes of endoscopic mucosal resection (EMR) with those of endoscopic submucosal dissection for SNADETs by propensity score matching analysis. Twenty-eight patients were matched in each group. EMR achieved shorter procedure time and hospital stay than endoscopic submucosal dissection without any significant differences in curability and safety. Therefore, EMR for SNADETs has an advantage in total medical costs of endoscopic treatment.
