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Short- and long-term outcomes of endoscopically treated superficial non-ampullary duodenal epithelial tumors

BACKGROUND: It is widely recognized that endoscopic resection (ER) of superficial non-ampullary duodenal epithelial tumors (SNADETs) is technically challenging and may carry high risks of intraoperative and delayed bleeding and perforation. These adverse events could be more critical than those occu...

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Autores principales: Hara, Yuko, Goda, Kenichi, Dobashi, Akira, Ohya, Tomohiko Richard, Kato, Masayuki, Sumiyama, Kazuki, Mitsuishi, Takehiro, Hirooka, Shinichi, Ikegami, Masahiro, Tajiri, Hisao
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6378536/
https://www.ncbi.nlm.nih.gov/pubmed/30783374
http://dx.doi.org/10.3748/wjg.v25.i6.707
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author Hara, Yuko
Goda, Kenichi
Dobashi, Akira
Ohya, Tomohiko Richard
Kato, Masayuki
Sumiyama, Kazuki
Mitsuishi, Takehiro
Hirooka, Shinichi
Ikegami, Masahiro
Tajiri, Hisao
author_facet Hara, Yuko
Goda, Kenichi
Dobashi, Akira
Ohya, Tomohiko Richard
Kato, Masayuki
Sumiyama, Kazuki
Mitsuishi, Takehiro
Hirooka, Shinichi
Ikegami, Masahiro
Tajiri, Hisao
author_sort Hara, Yuko
collection PubMed
description BACKGROUND: It is widely recognized that endoscopic resection (ER) of superficial non-ampullary duodenal epithelial tumors (SNADETs) is technically challenging and may carry high risks of intraoperative and delayed bleeding and perforation. These adverse events could be more critical than those occurring in other levels of the gastrointestinal tract. Because of the low prevalence of the disease and the high risks of severe adverse events, the curability including short- and long-term outcomes have not been standardized yet. AIM: To investigate the curability including short- and long-term outcomes of ER for SNADETs in a large case series. METHODS: This retrospective study included cases that underwent ER for SNADETs at our university hospital between March 2004 and July 2017. Short-term outcomes of ER were measured based on en bloc and R0 resection rates as well as adverse events. Long-term outcomes included local recurrence detected on endoscopic surveillance and disease-specific mortality in patients followed up for ≥ 12 mo after ER. RESULTS: In the study, 131 patients with 147 SNADETs were analyzed. The 147 ERs consisted of 136 endoscopic mucosal resections (EMRs) (93%) and 11 endoscopic submucosal dissections (ESDs) (7%). The median tumor diameter was 10 mm. The pathology diagnosis was adenocarcinoma (56/147, 38%), high-grade intraepithelial neoplasia (44/147, 30%), or low-grade intraepithelial neoplasia (47/147, 32%). The R0 resection rate was 68% (93/136) in the EMR group and 73% (8/11) in the ESD group, respectively. Cap-assisted EMR (known as EMR-C) showed a higher rate of R0 resection compared to the conventional method of EMR using a snare (78% vs 62%, P = 0.06). No adverse event was observed in the EMR group, whereas delayed bleeding, intraoperative perforation, and delayed perforation in 3, 3, and 5 patients occurred in the ESD group, respectively. One patient with perforation required emergency surgery. In the 43 mo median follow-up period, local recurrence was found in four EMR cases and all cases were treated endoscopically. No patient died due to tumor recurrence. CONCLUSION: Our findings suggest that ER provides good long-term outcomes in the patients with SNADETs. EMR is likely to become the safe and reliable treatment for small SNADETs.
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spelling pubmed-63785362019-02-19 Short- and long-term outcomes of endoscopically treated superficial non-ampullary duodenal epithelial tumors Hara, Yuko Goda, Kenichi Dobashi, Akira Ohya, Tomohiko Richard Kato, Masayuki Sumiyama, Kazuki Mitsuishi, Takehiro Hirooka, Shinichi Ikegami, Masahiro Tajiri, Hisao World J Gastroenterol Retrospective Study BACKGROUND: It is widely recognized that endoscopic resection (ER) of superficial non-ampullary duodenal epithelial tumors (SNADETs) is technically challenging and may carry high risks of intraoperative and delayed bleeding and perforation. These adverse events could be more critical than those occurring in other levels of the gastrointestinal tract. Because of the low prevalence of the disease and the high risks of severe adverse events, the curability including short- and long-term outcomes have not been standardized yet. AIM: To investigate the curability including short- and long-term outcomes of ER for SNADETs in a large case series. METHODS: This retrospective study included cases that underwent ER for SNADETs at our university hospital between March 2004 and July 2017. Short-term outcomes of ER were measured based on en bloc and R0 resection rates as well as adverse events. Long-term outcomes included local recurrence detected on endoscopic surveillance and disease-specific mortality in patients followed up for ≥ 12 mo after ER. RESULTS: In the study, 131 patients with 147 SNADETs were analyzed. The 147 ERs consisted of 136 endoscopic mucosal resections (EMRs) (93%) and 11 endoscopic submucosal dissections (ESDs) (7%). The median tumor diameter was 10 mm. The pathology diagnosis was adenocarcinoma (56/147, 38%), high-grade intraepithelial neoplasia (44/147, 30%), or low-grade intraepithelial neoplasia (47/147, 32%). The R0 resection rate was 68% (93/136) in the EMR group and 73% (8/11) in the ESD group, respectively. Cap-assisted EMR (known as EMR-C) showed a higher rate of R0 resection compared to the conventional method of EMR using a snare (78% vs 62%, P = 0.06). No adverse event was observed in the EMR group, whereas delayed bleeding, intraoperative perforation, and delayed perforation in 3, 3, and 5 patients occurred in the ESD group, respectively. One patient with perforation required emergency surgery. In the 43 mo median follow-up period, local recurrence was found in four EMR cases and all cases were treated endoscopically. No patient died due to tumor recurrence. CONCLUSION: Our findings suggest that ER provides good long-term outcomes in the patients with SNADETs. EMR is likely to become the safe and reliable treatment for small SNADETs. Baishideng Publishing Group Inc 2019-02-14 2019-02-14 /pmc/articles/PMC6378536/ /pubmed/30783374 http://dx.doi.org/10.3748/wjg.v25.i6.707 Text en ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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.
spellingShingle Retrospective Study
Hara, Yuko
Goda, Kenichi
Dobashi, Akira
Ohya, Tomohiko Richard
Kato, Masayuki
Sumiyama, Kazuki
Mitsuishi, Takehiro
Hirooka, Shinichi
Ikegami, Masahiro
Tajiri, Hisao
Short- and long-term outcomes of endoscopically treated superficial non-ampullary duodenal epithelial tumors
title Short- and long-term outcomes of endoscopically treated superficial non-ampullary duodenal epithelial tumors
title_full Short- and long-term outcomes of endoscopically treated superficial non-ampullary duodenal epithelial tumors
title_fullStr Short- and long-term outcomes of endoscopically treated superficial non-ampullary duodenal epithelial tumors
title_full_unstemmed Short- and long-term outcomes of endoscopically treated superficial non-ampullary duodenal epithelial tumors
title_short Short- and long-term outcomes of endoscopically treated superficial non-ampullary duodenal epithelial tumors
title_sort short- and long-term outcomes of endoscopically treated superficial non-ampullary duodenal epithelial tumors
topic Retrospective Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6378536/
https://www.ncbi.nlm.nih.gov/pubmed/30783374
http://dx.doi.org/10.3748/wjg.v25.i6.707
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