BACKGROUND Duodenal subepithelial lesions (D-SELs) are rare and their resection is challenging. Unfortunately, data on surgical and endoscopic resection of D-SELs are scarce. This study aimed to assess the safety and efficacy of surgical resection and endoscopic resection (ER) for D-SELs. METHODS We retrospectively analyzed clinical data of patients with non-ampullary D-SELs who underwent ER or surgery and compared the outcomes between ER and surgery with no/low-risk SELs over 15 mm from March 2010 to August 2020. Clinicopathologic findings, procedure-related parameters, and follow-up data were analyzed. RESULTS A total of 107 patients (108 lesions) were enrolled; 52 patients (53 lesions) received ER and 55 patients (55 lesions) received surgery. In ER group, en bloc resection rate and R0 resection rate were 94 and 89%, respectively. Major adverse events rate was 6%. One (2%) patient experienced local recurrence. In surgery group, R0 resection was achieved in all cases. Major adverse events rate was 20%. Recurrence rate and distant metastases rate were 4 and 8%, respectively. One (2%) patient died from septicemia during follow-up. Thirty-three patients in each group were enrolled in the comparison. There were no significant differences in age, sex, lesion size and location (P > 0.05). More histologically GISTs and muscularis propria-originated lesions were treated by surgery (P < 0.05). ER was significantly associated with a shorter operation time, shorter hospital stay, lower cost, less estimated blood loss, and lower major adverse events rate compared to the surgery group (P < 0.05). However, R0 resection rate, mortality, recurrence rate, and metastases rate were not significant different (P > 0.05). CONCLUSIONS ER is an effective and safe treatment modality for selected patients with non-ampullary D-SELs by expert endoscopists. Surgery is a radical method for D-SELs that should be reserved for D-SELs not amenable to ER.

中文翻译：

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手术和内镜切除术治疗十二指肠上皮下病变的安全性和有效性。

背景 十二指肠上皮下病变 (D-SEL) 很少见，切除它们具有挑战性。不幸的是，关于 D-SEL 手术和内窥镜切除的数据很少。本研究旨在评估手术切除和内镜切除 (ER) 治疗 D-SEL 的安全性和有效性。方法 我们回顾性分析了 2010 年 3 月至 2020 年 8 月接受 ER 或手术的非壶腹 D-SEL 患者的临床数据，并比较了 ER 和手术之间无/低风险 SEL 超过 15 mm 的结果。相关参数，并对随访数据进行分析。结果 共纳入 107 名患者（108 个病灶）；52 名患者（53 个病灶）接受了 ER，55 名患者（55 个病灶）接受了手术。ER组整块切除率和R0切除率分别为94%和89%。主要不良事件发生率为 6%。一名 (2%) 患者出现局部复发。手术组均达到R0切除。主要不良事件发生率为 20%。复发率和远处转移率分别为 4% 和 8%。一名 (2%) 患者在随访期间死于败血症。每组有 33 名患者参加了比较。年龄、性别、病变大小和部位差异无统计学意义（P>0.05）。更多组织学上的 GIST 和固有肌层起源的病变通过手术治疗 (P < 0.05)。与手术组相比，ER 与更短的手术时间、更短的住院时间、更低的成本、更少的估计失血量和更低的主要不良事件发生率显着相关（P < 0.05）。然而，R0切除率、死亡率、复发率、和转移率无显着差异（P > 0.05）。结论 对于内镜专家选择的非壶腹 D-SEL 患者，ER 是一种有效且安全的治疗方式。手术是 D-SEL 的一种根治方法，应该保留给不适合 ER 的 D-SEL。