经黏膜下注射和标记的水下内镜黏膜切除术治疗非壶腹性十二指肠浅表上皮性肿瘤以实现 R0 切除：单中心病例系列。

'Underwater endoscopic mucosal resection with submucosal injection and marking' for superficial non-ampullary duodenal epithelial tumors to achieve R0 resection: a single-center case series.

机构信息

Department of Endoscopy, Nagasaki University Hospital, Nagasaki, Japan.

Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.

出版信息

Scand J Gastroenterol. 2023 Jul;58(7):813-821. doi: 10.1080/00365521.2023.2171315. Epub 2023 Jan 28.

DOI:10.1080/00365521.2023.2171315

PMID:36708197

Abstract

OBJECTIVES

To describe an endoscopic technique named 'underwater endoscopic mucosal resection (UEMR) with submucosal injection and marking (UEMR-SIM)' and to evaluate the therapeutic characteristics of superficial non-ampullary duodenal epithelial tumors (SNADETs) < 20 mm vis-a-vis classical EMR (CEMR) and UEMR techniques.

MATERIALS AND METHODS

This retrospective study included 103 consecutive SNADET patients (103 lesions) who underwent CEMR, UEMR, or UEMR-SIM. The UEMR-SIM procedure included (1) marking and submucosal injection, (2) filling of the duodenal lumen with 0.9% saline, (3) snaring of the lesion, and (4) electrosurgical removal. The procedural outcomes were compared between the UEMR-SIM and other-procedure groups.

RESULTS

The resection rate was significantly higher in the UEMR-SIM group (100%) than in the CEMR group (76.8%) ( = 0.015) but was not statistically different between the UEMR-SIM and UEMR groups (88.0%) ( = 0.236). The R0 resection rate was significantly higher in the UEMR-SIM group (90.9%) than in the UEMR group (48.0%) ( = 0.001) but was not statistically different between the UEMR-SIM and CEMR groups (76.8%) ( = 0.209).

CONCLUSIONS

Our study indicates that the proposed method, UEMR-SIM for SNADETs, is feasible to achieve a high R0 resection rate and a potentially low local recurrence rate.

摘要

目的

描述一种名为“水下内镜黏膜切除术（UEMR）联合黏膜下注射和标记（UEMR-SIM）”的内镜技术，并评估该技术治疗直径＜20mm 的非壶腹型十二指肠上皮性肿瘤（SNADETs）的疗效，与传统内镜黏膜切除术（CEMR）和 UEMR 技术相比。

材料和方法

本回顾性研究纳入了 103 例连续的 SNADET 患者（103 个病灶），这些患者分别接受了 CEMR、UEMR 或 UEMR-SIM 治疗。UEMR-SIM 操作流程包括：（1）标记和黏膜下注射；（2）用 0.9%生理盐水填充十二指肠腔；（3）圈套病变；（4）电切切除。比较了 UEMR-SIM 组与其他治疗组之间的操作结果。

结果

UEMR-SIM 组的完全切除率（100%）明显高于 CEMR 组（76.8%）（ = 0.015），但与 UEMR 组（88.0%）相比差异无统计学意义（ = 0.236）。UEMR-SIM 组的 R0 切除率（90.9%）明显高于 UEMR 组（48.0%）（ = 0.001），但与 CEMR 组（76.8%）相比差异无统计学意义（ = 0.209）。