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
Superficial nonampullary duodenal epithelial tumors (SNADETs) are uncommon, but small early SNADETs are now being diagnosed more frequently, and thus, the demand for endoscopic resection (ER) has increased. However, the duodenum is the most challenging location in the gastrointestinal tract for ER.
Duodenal lesions that require ER are limited in number, and thus, although several reports have been published on the topic, little information is available on the long-term clinical outcomes of ER for SNADETs.
The objective of this investigation was to evaluate the safety and efficacy of ER for the treatment of SNADETs and associated factors using a 10-year follow-up.
This retrospective analysis was conducted on 56 consecutive patients with 58 lesions who underwent endoscopic mucosal resection (EMR; 57 lesions), and snare polypectomy (one lesion) for SNADETs from January 2011 to December 2020. 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.
Lesions consisted of 52 adenomas with low-grade dysplasia, 3 adenomas with high-grade dysplasia, and 3 intramucosal adenocarcinomas. There were 16 cases of intraprocedural bleeding (27.6%) and 1 case of delayed bleeding (1.7%), and 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. 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.
The majority of SNADETs can be safely and curatively resected by EMR, even when resection is piecemeal. However, larger lesions are associated with EMR-related bleeding, which has implications for risk management and surveillance strategies.
This study covers a 10-year period and benefits from meticulous, long-term follow-up in terms of determining clinical outcomes that reflect the safety and efficacy of EMR for SNADETs and natural history after EMR. Further larger-scale studies are needed to determine the long-term outcomes of ER for SNADETs.