Background and Aims

Pancreaticoduodenectomy is an invasive procedure, and endoscopic resection (ER) is an alternative therapy. However, details regarding the outcomes of ER are unknown, especially for superficial duodenal epithelial neoplasia (SDET). The aim of this study was to elucidate the outcomes of ER for SDET and to compare EMR with endoscopic submucosal dissection (ESD).

Methods

This was a retrospective observational study. From June 2010 to June 2017, 320 cases of endoscopically resected SDET (146 EMR-treated cases and 174 ESD-treated cases) were included in this study. We analyzed the proportions of en bloc resection, R0 resection, perforation, and bleeding as outcomes of ER and compared outcomes between the EMR and ESD groups. Next, we collected data on the features and clinical course of cases with adverse events.

Results

The proportions of en bloc resection and R0 resection among all cases were 96.6% and 83.4%, respectively. In over 95% of cases, ESD achieved en bloc resection, regardless of lesion size. The incidences of perforation and bleeding were 8.8% and 3.4%, respectively, and the former was largely successfully managed by conservative treatment. The mortality rate was 0%, and all patients were discharged with a median hospital stay of 8.5 days (range, 4–52 days). Evaluation of the hospital stay duration according to lesion circumference revealed a significantly longer duration for lesions present on the medial wall than for other lesions (median 41 vs 7 days, P = .0331).

Conclusion

The present study revealed that ER achieved secure en bloc resection, with the treatment type (ESD or EMR) selected according to the lesion size. A lesion located on the medial wall was associated with worse outcomes, such as prolonged hospital stay after perforation.

中文翻译：

---

十二指肠浅表上皮瘤形成的内镜切除结果

背景和目标

胰十二指肠切除术是一种侵入性手术，内镜切除术（ER）是另一种治疗方法。但是，有关ER结局的细节尚不清楚，尤其是对于十二指肠浅表上皮瘤样变（SDET）。这项研究的目的是阐明SDET的ER结果，并将EMR与内镜黏膜下剥离术（ESD）进行比较。

方法

这是一项回顾性观察研究。从2010年6月至2017年6月，本研究纳入了320例经内镜切除的SDET（146例接受EMR治疗的病例和174例ESD治疗的病例）。我们分析了整体切除，R0切除，穿孔和出血作为ER结局的比例，并比较了EMR和ESD组之间的结局。接下来，我们收集了有关不良事件病例的特征和临床过程的数据。

结果

在所有病例中，整体切除和R0切除的比例分别为96.6％和83.4％。在超过95％的病例中，无论病变大小如何，ESD都能实现整体切除。穿孔和出血的发生率分别为8.8％和3.4％，并且前者在很大程度上通过保守治疗得以成功治疗。死亡率为0％，所有患者均出院，中位住院天数为8.5天（4–52天）。根据病灶周长评估住院时间发现，与其他病灶相比，内侧壁上的病灶的病程明显更长（中位41 vs 7天，P  = .0331）。

结论

本研究表明，ER可以实现安全的整体切除，并根据病变大小选择治疗类型（ESD或EMR）。位于内侧壁的病变与较差的预后相关，例如穿孔后住院时间延长。