水下内镜黏膜切除术治疗浅表非壶腹十二指肠上皮肿瘤的疗效
Efficacy of Underwater Endoscopic Mucosal Resection for Superficial Non-Ampullary Duodenal Epithelial Tumor.
作者信息
Furukawa Masanori, Mitoro Akira, Ozutumi Takahiro, Fujinaga Yukihisa, Nakanishi Keisuke, Kitagawa Koh, Saikawa Soichiro, Sato Sinya, Sawada Yasuhiko, Takaya Hiroaki, Kaji Kosuke, Kawaratani Hideto, Namisaki Tadashi, Moriya Kei, Akahane Takemi, Yamao Junichi, Yoshiji Hitoshi
机构信息
Division of Endoscopy, Nara Medical University Hospital, Nara, Japan.
Department of Gastroenterology, Nara Medical University, Nara, Japan.
出版信息
Clin Endosc. 2021 May;54(3):371-378. doi: 10.5946/ce.2020.147. Epub 2021 Feb 18.
BACKGROUND/AIMS: Endoscopic resection (ER) for superficial non-ampullary duodenal epithelial tumors (SNADETs) is challenging. Conventional endoscopic mucosal resection (CEMR) is also problematic due to the anatomical features of the duodenum. We compared the safety and efficacy of underwater endoscopic mucosal resection (UEMR) with those of CEMR through a retrospective analysis.
METHODS
Altogether, 44 consecutive patients with 46 SNADETs underwent ER (18 CEMR cases and 28 UEMR cases) between January 2016 and October 2019. We investigated the proportions of en bloc resection, R0 resection, complications, resection time, and total procedure time and compared the outcomes of patients from the CEMR group with those of patients from the UEMR group.
RESULTS
The median tumor size was 8.0 mm (range, 2.0-20.0 mm). The UEMR group showed a higher proportion of en bloc resection (96.4% vs. 72.2%, p<0.05) and significantly lower median resection time and total procedure time (4 min vs. 9.5 min, p<0.05 and 13 min vs. 19 min, p<0.05; respectively) than the CEMR group. No complications were observed. However, two patients treated with piecemeal resection in the CEMR group had residual tumors.
CONCLUSION
UEMR is a feasible therapeutic option for SNADETs. It can be recommended as a standard treatment.
背景/目的：对浅表非壶腹十二指肠上皮肿瘤（SNADETs）进行内镜切除（ER）具有挑战性。由于十二指肠的解剖特征，传统内镜黏膜切除术（CEMR）也存在问题。我们通过回顾性分析比较了水下内镜黏膜切除术（UEMR）与CEMR的安全性和有效性。
方法
2016年1月至2019年10月期间，共有44例连续的46个SNADETs患者接受了ER（18例CEMR病例和28例UEMR病例）。我们调查了整块切除、R0切除、并发症、切除时间和总手术时间的比例，并比较了CEMR组和UEMR组患者的结果。
结果
肿瘤大小中位数为8.0mm（范围2.0 - 20.0mm）。UEMR组的整块切除比例更高（96.4%对72.2%，p<0.05），且切除时间中位数和总手术时间显著低于CEMR组（分别为4分钟对9.5分钟，p<0.05；13分钟对19分钟，p<0.05）。未观察到并发症。然而，CEMR组中两名接受分片切除的患者有残留肿瘤。
结论
UEMR是SNADETs的一种可行治疗选择。可推荐作为标准治疗方法。
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