Molecular Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Department of Gastroenterology, Saiseikai Shigaken Hospital, Ritto, Japan.
Jpn J Clin Oncol. 2024 Feb 7;54(2):137-145. doi: 10.1093/jjco/hyad145.
Several endoscopic resection methods have been developed as less invasive treatments for superficial non-ampullary duodenal epithelial tumours. This study aimed to compare outcomes of conventional endoscopic mucosal resection and underwater endoscopic mucosal resection for superficial non-ampullary duodenal epithelial tumours, including resection depth and rate of the muscularis mucosa contained under the lesion.
This single-centre retrospective cohort study conducted from January 2009 to December 2021 enrolled patients who underwent conventional endoscopic mucosal resection and underwater endoscopic mucosal resection for superficial non-ampullary duodenal epithelial tumours and investigated their clinicopathological outcomes using propensity score matching.
Of the 285 superficial non-ampullary duodenal epithelial tumours, 98 conventional endoscopic mucosal resections and 187 underwater endoscopic mucosal resections were included. After propensity score matching, 64 conventional endoscopic mucosal resections and 64 underwater endoscopic mucosal resections were analysed. The R0 resection rate was significantly higher in underwater endoscopic mucosal resection cases than in conventional endoscopic mucosal resection cases (70.3% vs. 50.0%; P = 0.030). In the multivariate analysis, a lesion diameter > 10 mm (odds ratio 7.246; P = 0.001), being in the 1st-50th treatment period (odds ratio 3.405; P = 0.008), and undergoing conventional endoscopic mucosal resection (odds ratio 3.617; P = 0.016) were associated with RX/R1 resection. Furthermore, in underwater endoscopic mucosal resection cases, the R0 rate was significantly higher for lesions diameter ≤10 mm than >10 mm, and was significantly higher in the 51st-treatment period than in the 1st-50th period. Conventional endoscopic mucosal resection and underwater endoscopic mucosal resection cases showed no significant difference in resection depth and muscularis mucosa containing rate.
Underwater endoscopic mucosal resection may be more acceptable than conventional endoscopic mucosal resection for superficial non-ampullary duodenal epithelial tumours ≤ 10 mm. A steep early learning curve may be acquired for underwater endoscopic mucosal resection. Large multicentre prospective studies need to be conducted to confirm the effectiveness of underwater endoscopic mucosal resection.
为了对非壶腹性十二指肠黏膜上皮浅层肿瘤进行微创治疗，已经开发了几种内镜下切除术。本研究旨在比较常规内镜黏膜切除术和水下内镜黏膜切除术治疗非壶腹性十二指肠黏膜上皮浅层肿瘤的效果，包括切除深度和病变下黏膜肌层的包含率。
这是一项单中心回顾性队列研究，纳入了 2009 年 1 月至 2021 年 12 月期间接受常规内镜黏膜切除术和水下内镜黏膜切除术治疗的非壶腹性十二指肠黏膜上皮浅层肿瘤患者，并使用倾向评分匹配法对其临床病理结果进行了调查。
在 285 例非壶腹性十二指肠黏膜上皮浅层肿瘤中，纳入了 98 例行常规内镜黏膜切除术和 187 例行水下内镜黏膜切除术的患者。经过倾向评分匹配后，分析了 64 例行常规内镜黏膜切除术和 64 例行水下内镜黏膜切除术的患者。水下内镜黏膜切除术的 R0 切除率明显高于常规内镜黏膜切除术（70.3% vs. 50.0%；P = 0.030）。多变量分析显示，病灶直径>10mm（比值比 7.246；P = 0.001）、处于第 1-50 个治疗期（比值比 3.405；P = 0.008）和接受常规内镜黏膜切除术（比值比 3.617；P = 0.016）与 RX/R1 切除有关。此外，在水下内镜黏膜切除术病例中，病灶直径≤10mm 的 R0 率明显高于直径>10mm 的 R0 率，第 51 个治疗期的 R0 率明显高于第 1-50 个治疗期的 R0 率。常规内镜黏膜切除术和水下内镜黏膜切除术在切除深度和黏膜肌层包含率方面无显著差异。
对于直径≤10mm 的非壶腹性十二指肠黏膜上皮浅层肿瘤，水下内镜黏膜切除术可能比常规内镜黏膜切除术更可取。水下内镜黏膜切除术可能有一个陡峭的早期学习曲线。需要进行大型多中心前瞻性研究来证实水下内镜黏膜切除术的有效性。
