BACKGROUND AND AIM The endoscopic treatment of non-lifting or submucosal duodenal lesions is associated with a high risk of incomplete resection and adverse events. Clip-assisted endoscopic full-thickness resection (EFTR) is a new approach for en bloc removal of neoplastic lesions in the GI tract. The aim of this study was to investigate its efficacy and safety in the duodenum. MATERIALS AND METHODS We retrospectively collected all consecutive patients with duodenal lesions who underwent EFTR with OTSC (Ovesco Endoscopy, Tübingen, Germany) or the new full-thickness resection device (FTRD; Ovesco Endoscopy, Tübingen, Germany). Complete resection rate was defined as histologically-verified R0 resection. Main endoscopic and clinical outcomes (technical success, rate of EFTR, adverse events) were systematically assessed at 3 and 6 months. RESULTS Between May 2017 and January 2019, 10 patients with duodenal lesions underwent EFTR (5 non-lifting adenomas, 2 adenomas recurrence/relapse and 3 subepithelial tumours). Technical success was overall achieved in 8/10 cases (80%). The two FTRD failed cases were completed with snare resection. The complete full-thickness resection rate was achieved in 8/10 (80%), while in two cases it was limited to mucosal or submucosal layer. R0 resection rate was achieved in 8/10 (80%) patients. The mean procedure time was 75 min (range 53-120 min). There were no major adverse events. At 3 and 6-month follow-up, no recurrence was observed. CONCLUSIONS Clip-assisted EFTR is a feasible and effective technique for en bloc resection of "difficult" superficial neoplasia and submucosal lesions in the duodenum, representing another technique that must be part of the endoscopist's armamentarium.

中文翻译：

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十二指肠病变的内镜全层切除（附视频）。

背景和目的 内镜治疗非提拉型或黏膜下十二指肠病变与不完全切除和不良事件的高风险相关。夹子辅助内窥镜全层切除术（EFTR）是一种整块切除胃肠道肿瘤性病变的新方法。本研究的目的是调查其在十二指肠的疗效和安全性。材料和方法 我们回顾性收集了所有连续接受 OTSC（Ovesco 内窥镜，德国蒂宾根）或新的全层切除装置（FTRD；Ovesco 内窥镜，德国蒂宾根）的 EFTR 的十二指肠病变患者。完全切除率定义为经组织学验证的 R0 切除。在 3 个月和 6 个月时系统地评估了主要的内窥镜和临床结果（技术成功率、EFTR 发生率、不良事件）。结果 2017 年 5 月至 2019 年 1 月，10 例十二指肠病变患者接受了 EFTR（5 例非提拉腺瘤、2 例腺瘤复发/复发和 3 例上皮下肿瘤）。在 8/10 (80%) 的案例中总体上取得了技术成功。两个 FTRD 失败病例均通过圈套器切除完成。8/10 (80%) 达到了完全全层切除率，而在两个病例中，它仅限于黏膜或黏膜下层。8/10 (80%) 患者达到 R0 切除率。平均手术时间为 75 分钟（范围 53-120 分钟）。未发生重大不良事件。在 3 个月和 6 个月的随访中，未观察到复发。结