Feasibility study comparing underwater endoscopic mucosal resection and conventional endoscopic mucosal resection for superficial non‐ampullary duodenal epithelial tumor < 20 mm

• DOI: 10.1111/den.13524
• Publication Date: 2019-09-09T16:35:22Z
• Authors: Yoshiyuki Kiguchi; Motohiko Kato; Atsushi Nakayama; Motoki Sasaki; Mari Mizutani; Koushiro Tsutsumi; Teppei Akimoto; Yusaku Takatori; Makoto Mutaguchi; Kaoru Takabayashi; Yasutoshi Ochiai; Tadateru Maehata; Takanori Kanai; Naohisa Yahagi
• Keywords: 03 medical and health sciences; 0302 clinical medicine; Endoscopic Mucosal Resection; Feasibility Studies; Humans; Neoplasms, Glandular and Epithelial; Prospective Studies; Intestinal Mucosa; Retrospective Studies

Background and AimUnderwater endoscopic mucosal resection (UEMR) has been reported as an alternative to conventional EMR for superficial non‐ampullary duodenal epithelial tumors (SNADET). However, the detailed outcomes are unclear. This study aimed to compare the clinical outcomes between UEMR and EMR for SNADET <20 mm.Patients and methodsThis is a retrospective observational study using a prospective maintained database. From November 2017 to December 2018, 104 consecutive cases of attempted UEMR for SNADET <20 mm were prospectively allocated. A total of 240 cases of attempted EMR were chosen as historical controls. We compared technical success rate, defined as the resection rate without conversion to ESD; en bloc resection rate; R0 resection rate; and adverse event rate. Next, multivariate analyses were constructed to identify predictors of conversion to ESD, piecemeal resection, and RX or R1 (RX/R1) resection.ResultsTechnical success rate of UEMR was significantly higher than that of EMR (87% and 70%, P < 0.01). En bloc resection and R0 resection rates of UEMR were significantly lower than those of EMR (en bloc resection: 87% vs 96%, P < 0.01; R0 resection: 67% vs 80%, P = 0.05). Concerning adverse events, there were no significant differences. In multivariate analyses, attempted EMR, lesion size and depressed type were independent predictors of conversion to ESD. Attempted UEMR was an independent predictor of piecemeal resection and RX/R1 resection.ConclusionThe present study indicated that UEMR could be a feasible endoscopic resection method for SNADET (UMIN000025442).