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

• Published in: Digestive endoscopy Vol. 32; no. 5; pp. 753 - 760
• Main Authors: Kiguchi, Yoshiyuki, Kato, Motohiko, Nakayama, Atsushi, Sasaki, Motoki, Mizutani, Mari, Tsutsumi, Koushiro, Akimoto, Teppei, Takatori, Yusaku, Mutaguchi, Makoto, Takabayashi, Kaoru, Ochiai, Yasutoshi, Maehata, Tadateru, Kanai, Takanori, Yahagi, Naohisa
• Format: Journal Article
• Language: English
• Published: Australia 01-07-2020
• Subjects: conventional endoscopic mucosal resection; feasibility study; superficial non-ampullary duodenal epithelial tumor; technical success rate; underwater endoscopic mucosal resection; superficial non-ampullary duodenal epithelial tumor; technical success rate; conventional endoscopic mucosal resection; feasibility study; underwater endoscopic mucosal resection
• ISSN: 0915-5635; 1443-1661
• DOI: 10.1111/den.13524

Background and Aim
Underwater 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 methods
This 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.
Results
Technical 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.
Conclusion
The present study indicated that UEMR could be a feasible endoscopic resection method for SNADET (UMIN000025442).