Outcomes of endoscopic resection for superficial duodenal tumors: 10 years’ experience in 18 Japanese high volume centers

Motohiko Kato; Yoji Takeuchi; Shu Hoteya; Tsuneo Oyama; Satoru Nonaka; Shoichi Yoshimizu; Naomi Kakushima; Ken Ohata; Hironori Yamamoto; Yuko Hara; Hisashi Doyama; Osamu Dohi; Yasushi Yamasaki; Hiroya Ueyama; Kengo Takimoto; Koichi Kurahara; Tomoaki Tashima; Nobutsugu Abe; Atsushi Nakayama; Ichiro Oda; Naohisa Yahagi

doi:10.1055/a-1640-3236

Endoscopy, Table of Contents

Endoscopy 2022; 54(07): 663-670
DOI: 10.1055/a-1640-3236

Original article

Outcomes of endoscopic resection for superficial duodenal tumors: 10 years’ experience in 18 Japanese high volume centers

Motohiko Kato

¹Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan

,

Yoji Takeuchi

²Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan

,

Shu Hoteya

³Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan

,

Tsuneo Oyama

⁴Department of Endoscopy, Saku Central Hospital Advanced Care Center, Nagano, Japan

,

Satoru Nonaka

⁵Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan

,

Shoichi Yoshimizu

⁶Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan

,

Naomi Kakushima

⁷Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan

,

Ken Ohata

⁸Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan

,

Hironori Yamamoto

⁹Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan

,

Yuko Hara

¹⁰Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan

,

Hisashi Doyama

¹¹Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan

,

Osamu Dohi

¹²Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

,

Yasushi Yamasaki

¹³Department of Gastroenterology, Okayama University Hospital, Okayama, Japan

,

Hiroya Ueyama

¹⁴Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan

,

Kengo Takimoto

¹⁵Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan

,

Koichi Kurahara

¹⁶Division of Gastroenterology, Matsuyama Red Cross Hospital, Matsuyama, Japan

,

Tomoaki Tashima

¹⁷Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan

,

Nobutsugu Abe

¹⁸Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan

,

Atsushi Nakayama

¹Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan

,

Ichiro Oda

⁵Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan

,

Naohisa Yahagi

¹Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan

› Author Affiliations

Abstract

Background Data on endoscopic resection (ER) for superficial duodenal epithelial tumors (SDETs) are insufficient owing to their rarity. There are two main ER techniques for SDETs: endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). In addition, modified EMR techniques, such as underwater EMR (UEMR) and cold polypectomy, are becoming popular. We conducted a large-scale retrospective multicenter study to clarify the detailed outcomes of duodenal ER.

Methods Patients with SDETs who underwent ER at 18 institutions from January 2008 to December 2018 were included. The rates of en bloc resection and delayed adverse events (AEs; defined as delayed bleeding or perforation) were analyzed. Local recurrence was analyzed using the Kaplan–Meier method.

Results In total, 3107 patients (including 1017 undergoing ESD) were included. En bloc resection rates were 79.1 %, 78.6 %, 86.8 %, and 94.8 %, and delayed AE rates were 0.5 %, 2.2 %, 2.8 %, and 6.8 % for cold polypectomy, UEMR, EMR and ESD, respectively. The delayed AE rate was significantly higher in the ESD group than in non-ESD groups for lesions < 19 mm (7.4 % vs. 1.9 %; P < 0.001), but not for lesions > 20 mm (6.1 % vs. 7.1 %; P = 0.64). The local recurrence rate was significantly lower in the ESD group than in the non-ESD groups (P < 0.001). Furthermore, for lesions > 30 mm, the cumulative local recurrence rate at 2 years was 22.6 % in the non-ESD groups compared with only 1.6 % in the ESD group (P < 0.001).

Conclusions ER outcomes for SDETs were generally acceptable. ESD by highly experienced endoscopists might be an option for very large SDETs.

Full Text

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Supplementary Material

Supplementary material