Clinical Features and Outcomes of Endoscopic Resection of Superficial Nonampullary Duodenal Tumors in South Korea: A 15-Year Retrospective Study.
Data on outcomes of superficial nonampullary duodenal tumors (SNADETs) are limited. We evaluated clinical features, outcomes, and complications of endoscopic resection (ER) in a large single-center cohort.
Patients who underwent ER for SNADETs between 2008 and 2023 were retrospectively reviewed. Clinicopathologic features, resection outcomes, adverse events, and recurrence were analyzed.
A total of 176 SNADETs from 163 patients (mean age, 57±13 years; 56.4% male) were included. The median follow-up duration was 22 months. The mean lesion size was 9.8±5.4 mm. ER methods were cold snare polypectomy (CSP) (n=29), cold endoscopic mucosal resection (EMR) (n=42), hot EMR (n=83), endoscopic submucosal dissection (ESD) (n=13), and underwater EMR (n=8). En bloc and histologic curative resection rates were 85.7% and 91.5%, respectively. Bleeding occurred in nine patients (5.1%), and perforation occurred in three patients (1.7%); both were mostly managed endoscopically. Bleeding was more common in the second portion of duodenum, and with hot EMR and ESD, whereas no bleeding occurred after CSP or underwater EMR. CSP and underwater EMR showed the shortest procedure times, whereas cold EMR and hot EMR had longer procedure times; ESD had the longest procedure time. Local recurrence occurred after en bloc curative ESD in one patient (0.6%).
ER is effective and safe for SNADETs, achieving high curative resection rates, low recurrence, and acceptable complication risks. Selection of resection method should be individualized, with cold EMR and underwater EMR offering safe and efficient alternatives for the treatment of smaller lesions, while ESD may be reserved for the treatment of larger lesions or complex cases.
Patients who underwent ER for SNADETs between 2008 and 2023 were retrospectively reviewed. Clinicopathologic features, resection outcomes, adverse events, and recurrence were analyzed.
A total of 176 SNADETs from 163 patients (mean age, 57±13 years; 56.4% male) were included. The median follow-up duration was 22 months. The mean lesion size was 9.8±5.4 mm. ER methods were cold snare polypectomy (CSP) (n=29), cold endoscopic mucosal resection (EMR) (n=42), hot EMR (n=83), endoscopic submucosal dissection (ESD) (n=13), and underwater EMR (n=8). En bloc and histologic curative resection rates were 85.7% and 91.5%, respectively. Bleeding occurred in nine patients (5.1%), and perforation occurred in three patients (1.7%); both were mostly managed endoscopically. Bleeding was more common in the second portion of duodenum, and with hot EMR and ESD, whereas no bleeding occurred after CSP or underwater EMR. CSP and underwater EMR showed the shortest procedure times, whereas cold EMR and hot EMR had longer procedure times; ESD had the longest procedure time. Local recurrence occurred after en bloc curative ESD in one patient (0.6%).
ER is effective and safe for SNADETs, achieving high curative resection rates, low recurrence, and acceptable complication risks. Selection of resection method should be individualized, with cold EMR and underwater EMR offering safe and efficient alternatives for the treatment of smaller lesions, while ESD may be reserved for the treatment of larger lesions or complex cases.