内镜切除治疗十二指肠浅表肿瘤的疗效：18 家日本高容量中心 10 年的经验。

Outcomes of endoscopic resection for superficial duodenal tumors: 10 years' experience in 18 Japanese high volume centers.

机构信息

Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan.

Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.

出版信息

Endoscopy. 2022 Jul;54(7):663-670. doi: 10.1055/a-1640-3236. Epub 2021 Oct 28.

DOI:10.1055/a-1640-3236

PMID:34496422

Abstract

BACKGROUND

Data on endoscopic resection (ER) for superficial duodenal epithelial tumors (SDETs) are insufficient owing to their rarity. There are two main ER techniques for SDETs: endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). In addition, modified EMR techniques, such as underwater EMR (UEMR) and cold polypectomy, are becoming popular. We conducted a large-scale retrospective multicenter study to clarify the detailed outcomes of duodenal ER.

METHODS

Patients with SDETs who underwent ER at 18 institutions from January 2008 to December 2018 were included. The rates of en bloc resection and delayed adverse events (AEs; defined as delayed bleeding or perforation) were analyzed. Local recurrence was analyzed using the Kaplan-Meier method.

RESULTS

In total, 3107 patients (including 1017 undergoing ESD) were included. En bloc resection rates were 79.1 %, 78.6 %, 86.8 %, and 94.8 %, and delayed AE rates were 0.5 %, 2.2 %, 2.8 %, and 6.8 % for cold polypectomy, UEMR, EMR and ESD, respectively. The delayed AE rate was significantly higher in the ESD group than in non-ESD groups for lesions < 19 mm (7.4 % vs. 1.9 %; < 0.001), but not for lesions > 20 mm (6.1 % vs. 7.1 %; = 0.64). The local recurrence rate was significantly lower in the ESD group than in the non-ESD groups ( < 0.001). Furthermore, for lesions > 30 mm, the cumulative local recurrence rate at 2 years was 22.6 % in the non-ESD groups compared with only 1.6 % in the ESD group ( < 0.001).

CONCLUSIONS

ER outcomes for SDETs were generally acceptable. ESD by highly experienced endoscopists might be an option for very large SDETs.

摘要

背景

由于十二指肠上皮性肿瘤（SDETs）较为罕见，因此内镜下切除术（ER）的数据不足。对于 SDETs 有两种主要的 ER 技术：内镜黏膜切除术（EMR）和内镜黏膜下剥离术（ESD）。此外，水下 EMR（UEMR）和冷息肉切除术等改良 EMR 技术也越来越流行。我们进行了一项大规模的回顾性多中心研究，以明确十二指肠 ER 的详细结果。

方法

纳入 2008 年 1 月至 2018 年 12 月在 18 家机构接受 ER 治疗的 SDETs 患者。分析整块切除率和延迟不良事件（定义为延迟性出血或穿孔）的发生率。采用 Kaplan-Meier 法分析局部复发情况。

结果

共纳入 3107 例患者（包括 1017 例行 ESD）。整块切除率分别为冷息肉切除术 79.1%、UEMR 78.6%、EMR 86.8%和 ESD 94.8%，冷息肉切除术、UEMR、EMR 和 ESD 的延迟性 AE 发生率分别为 0.5%、2.2%、2.8%和 6.8%。对于＜19mm 的病变，ESD 组的延迟性 AE 发生率明显高于非 ESD 组（7.4% vs. 1.9%；＜0.001），但对于＞20mm 的病变，两组间差异无统计学意义（6.1% vs. 7.1%；=0.64）。ESD 组的局部复发率明显低于非 ESD 组（＜0.001）。此外，对于＞30mm 的病变，非 ESD 组 2 年的累积局部复发率为 22.6%，而 ESD 组仅为 1.6%（＜0.001）。