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

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

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1 Citation (Scopus)

Abstract

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).

Original languageEnglish
JournalDigestive Endoscopy
DOIs
Publication statusAccepted/In press - 2019 Jan 1

Fingerprint

Feasibility Studies
Neoplasms
Multivariate Analysis
Endoscopic Mucosal Resection
Observational Studies
Retrospective Studies
Databases

Keywords

  • conventional endoscopic mucosal resection
  • feasibility study
  • superficial non-ampullary duodenal epithelial tumor
  • technical success rate
  • underwater endoscopic mucosal resection

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

@article{04c80a6fc246428ca55b1417ea137a38,
title = "Feasibility study comparing underwater endoscopic mucosal resection and conventional endoscopic mucosal resection for superficial non-ampullary duodenal epithelial tumor < 20 mm",
abstract = "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).",
keywords = "conventional endoscopic mucosal resection, feasibility study, superficial non-ampullary duodenal epithelial tumor, technical success rate, underwater endoscopic mucosal resection",
author = "Yoshiyuki Kiguchi and Motohiko Kato and Atsushi Nakayama and Motoki Sasaki and Mari Mizutani and Koushiro Tsutsumi and Teppei Akimoto and Yusaku Takatori and Makoto Mutaguchi and Kaoru Takabayashi and Yasutoshi Ochiai and Tadateru Maehata and Takanori Kanai and Naohisa Yahagi",
year = "2019",
month = "1",
day = "1",
doi = "10.1111/den.13524",
language = "English",
journal = "Digestive Endoscopy",
issn = "0915-5635",
publisher = "Wiley-Blackwell",

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TY - JOUR

T1 - Feasibility study comparing underwater endoscopic mucosal resection and conventional endoscopic mucosal resection for superficial non-ampullary duodenal epithelial tumor < 20 mm

AU - Kiguchi, Yoshiyuki

AU - Kato, Motohiko

AU - Nakayama, Atsushi

AU - Sasaki, Motoki

AU - Mizutani, Mari

AU - Tsutsumi, Koushiro

AU - Akimoto, Teppei

AU - Takatori, Yusaku

AU - Mutaguchi, Makoto

AU - Takabayashi, Kaoru

AU - Ochiai, Yasutoshi

AU - Maehata, Tadateru

AU - Kanai, Takanori

AU - Yahagi, Naohisa

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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).

AB - 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).

KW - conventional endoscopic mucosal resection

KW - feasibility study

KW - superficial non-ampullary duodenal epithelial tumor

KW - technical success rate

KW - underwater endoscopic mucosal resection

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U2 - 10.1111/den.13524

DO - 10.1111/den.13524

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