Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
Dig Endosc. 2020 Jul;32(5):753-760. doi: 10.1111/den.13524. Epub 2019 Oct 31.
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.
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.
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.
The present study indicated that UEMR could be a feasible endoscopic resection method for SNADET (UMIN000025442).
水下内镜黏膜切除术（UEMR）已被报道为治疗非壶腹型十二指肠上皮浅表肿瘤（SNADET）的一种替代传统内镜黏膜切除术（EMR）的方法。然而，其详细的结果尚不清楚。本研究旨在比较 UEMR 和 EMR 治疗直径＜20mm 的 SNADET 的临床疗效。
这是一项使用前瞻性维护数据库的回顾性观察性研究。从 2017 年 11 月至 2018 年 12 月，前瞻性分配了 104 例直径＜20mm 的 SNADET 患者进行 UEMR 尝试。选择了 240 例尝试 EMR 的病例作为历史对照。我们比较了技术成功率，定义为无转为内镜黏膜下剥离术（ESD）的切除率；整块切除率；R0 切除率；以及不良事件发生率。然后，构建了多变量分析来确定转为 ESD、分片切除和 RX 或 R1（RX/R1）切除的预测因素。
UEMR 的技术成功率明显高于 EMR（87%和 70%，P＜0.01）。UEMR 的整块切除率和 R0 切除率明显低于 EMR（整块切除率：87%比 96%，P＜0.01；R0 切除率：67%比 80%，P=0.05）。关于不良事件，两者之间没有显著差异。在多变量分析中，尝试 EMR、病变大小和凹陷型是转为 ESD 的独立预测因素。尝试 UEMR 是分片切除和 RX/R1 切除的独立预测因素。
本研究表明，UEMR 可能是一种治疗 SNADET 的可行内镜切除方法（UMIN000025442）。
