Published online Apr 27, 2022. doi: 10.4240/wjgs.v14.i4.329
Peer-review started: December 18, 2021
First decision: January 27, 2022
Revised: February 9, 2022
Accepted: March 26, 2022
Article in press: March 26, 2022
Published online: April 27, 2022
Processing time: 127 Days and 6 Hours
Although premalignant duodenal lesions such as adenomas are uncommon, the incidences of these lesions have increased in recent times, and thus, the demand for minimally invasive treatments such as endoscopic resection (ER) has also increased. However, ER in the duodenum is more challenging than ER in other locations of the gastrointestinal tract.
To evaluate the safety and efficacy of ER for superficial nonampullary duodenal epithelial tumors (SNADETs)
We performed a retrospective observational study on 56 consecutive patients (58 lesions) diagnosed with SNADETs that underwent ER from January 2011 to December 2020 at Yeungnam University Hospital. Patient demographics, lesion characteristics, and procedural and technical data were collected, and clinical outcomes, including procedure-related complications, completeness of resection, and recurrence were analyzed.
Median patient age was 57 years [range, 26–77, 30 (53.6%) men]. Endoscopic mucosal resection (EMR) was performed on 57 lesions (98.3%) and snare polypectomy on one (1.7%). Lesions consisted of 52 adenomas with low-grade dysplasia (89.7%), 3 adenomas with high-grade dysplasia (5.2%), and 3 intramucosal adenocarcinomas (5.2%). There were 16 cases of intraprocedural bleeding (27.6%) and 1 case of delayed bleeding (1.7%), and all these 17 cases were successfully managed endoscopically. No perforation or procedure-related death occurred. Larger lesion size was associated with an increased risk of EMR-related bleeding (P = 0.033). During a median follow-up period of 23 mo (range 6–100 mo), no local recurrence occurred, despite the fact one-third of the patients (19 lesions, 32.8%) underwent piecemeal resection and 3 patients (3 lesions, 5.2%) that underwent en bloc resection had a pathologically determined positive lateral margin. No patient died from a primary duodenal neoplasm.
The majority of SNADETs can be safely and curatively resected by EMR, and thus, based on consideration of the high incidence of fatal complications attributable to ESD, we conclude EMR, including piecemeal resection, should be considered the treatment of first choice for SNADETs.
Core Tip: This long-term retrospective observational study shows that superficial nonampullary duodenal epithelial tumors (SNADETs) can be safely and curatively managed by endoscopic mucosal resection (EMR), even after piecemeal resection. Therefore, based on consideration of the high incidence of fatal complications attributable to endoscopic submucosal dissection in duodenum, we recommend that EMR, including piecemeal resection, be considered the treatment of first choice for SNADETs. However, we caution that because of its technical difficulty, EMR on duodenum should only be performed by highly skilled endoscopists. In addition, we emphasize that more attention is required during EMR of a large duodenal tumor because lesion size is positively associated with the risk of EMR-related bleeding.