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CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(10): E976-E982
DOI: 10.1055/a-2161-2212
Original article

Efficacy and safety of cap-assisted endoscopic mucosal resection for superficial duodenal epithelial neoplasia ≤ 10 mm

Yoshiaki Kimoto
1   Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
,
Rikimaru Sawada
1   Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
,
Susumu Banjoya
1   Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
,
Toshifumi Iida
1   Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
,
Tomoya Kimura
1   Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
,
Koichi Furuta
1   Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
,
Shinya Nagae
1   Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
,
Yohei Ito
1   Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
,
Hiroshi Yamazaki
1   Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
,
Nao Takeuchi 
1   Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
,
Shunya Takayanagi
1   Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
,
Yuki Kano
1   Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
,
Takashi Sakuno
1   Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
,
Kohei Ono
1   Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
,
Ryoju Negishi
1   Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
,
Akiko Ohno 
2   Gastroenterology, Kyorin University Hospital, Tokyo, Japan, Mitaka, Japan (Ringgold ID: RIN12912)
,
Eiji Sakai
3   Gastroenterology, Yokohama Sakae Kyosai Hospital, Kanagawa, Japan, Yokohama, Japan
,
Yohei Minato
1   Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
,
Hideyuki Chiba 
4   Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan, Ota-Ku, Japan
,
Ken Ohata
1   Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
› Author Affiliations TRIAL REGISTRATION: Registration number (trial ID): UMIN000050919, Trial registry: UMIN Japan (http://www.umin.ac.jp/english/), Type of Study: a retrospective cohort study
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Abstract

Background and study aims Endoscopic treatment strategies for small superficial duodenal epithelial neoplasia (SDET) have not been established, and the R0 resection rates of all previously reported endoscopic techniques are somewhat low. Furthermore, no reports of cap-assisted endoscopic mucosal resection (EMRC), which is reportedly associated with a relatively high R0 resection rate, have been evaluated in sufficient numbers of patients. Therefore, we assessed the efficacy and safety of EMRC for SDETs ≤ 10 mm in a retrospective cohort study.

Patients and methods We examined a prospectively maintained database and identified 248 consecutive patients (248 lesions) who had undergone endoscopic resection for SDETs ≤ 10 mm between January 2017 and June 2022. Our treatment strategy was consistent, with EMRC indicated for all SDETs ≤ 10 mm without non-lifting signs. The primary endpoint was the R0 resection rate.

Results Overall, 20 lesions had non-lifting signs and were selected for endoscopic submucosal dissection, while the remaining 228 lesions were treated with EMRC. As a result of EMRC, the median tumor size was 5 mm, and the mean procedure time was 5 minutes. Most of the lesions (89.2%) were located in the descending part. The R0 resection rate was 97.4% (222/228 cases), and the en bloc resection rate was 99.6%. Only seven patients(3.1%) experienced adverse events (6 patients, delayed bleeding; 1 patient, acute pancreatitis), which were successfully managed without surgical intervention. Furthermore, no recurrences were observed.

Conclusions We have demonstrated that EMRC is an effective and safe treatment for SDETs ≤ 10 mm that do not have non-lifting signs.

Keywords

Endoscopy Upper GI Tract - Diagnosis and imaging (inc chromoendoscopy, NBI, iSCAN, FICE, CLE) - Endoscopic resection (ESD, EMRc, ...) - Endoscopy Small Bowel - Neoplasia


Publication History

Received: 29 June 2023

Accepted after revision: 25 August 2023

Accepted Manuscript online:
28 August 2023

Article published online:
11 October 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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