Morais Rui, Amorim José, Medas Renato, Sousa-Pinto Bernardo, Santos-Antunes João, Legros Romain, Albouys Jérémie, Moll Frédéric, Marques Margarida, Vilas-Boas Filipe, Rodrigues-Pinto Eduardo, Gullo Irene, Carneiro Fátima, Soares Elisa Gravito, Amaro Pedro, Mesquita Pedro, Rodrigues Jaime, Andrisani Gianluca, Sferrazza Sandro, Archer Sara, Kuttner-Magalhães Ricardo, Manzano Francisco, de Santiago Enrique Rodríguez, Rimondi Alessandro, Murino Alberto, Despott Edward, Pioche Mathieu, Jacques Jérémie, Macedo Guilherme
Gastroenterology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal.
Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal.
Clin Gastroenterol Hepatol. 2025 Jan;23(1):79-88.e4. doi: 10.1016/j.cgh.2024.05.011. Epub 2024 May 22.
BACKGROUND & AIMS: Conventional endoscopic mucosal resection (C-EMR) is established as the primary treatment modality for superficial nonampullary duodenal epithelial tumors (SNADETs), but recently underwater endoscopic mucosal resection (U-EMR) has emerged as a potential alternative. The majority of previous studies focused on Asian populations and small lesions (≤20 mm). We aimed to compare the efficacy and outcomes of U-EMR vs C-EMR for SNADETs in a Western setting.
This was a retrospective multinational study from 10 European centers that performed both C-EMR and U-EMR between January 2013 and July 2023. The main outcomes were the technical success, procedure-related adverse events (AEs), and the residual/recurrent adenoma (RRA) rate, evaluated on a per-lesion basis. We assessed the association between the type of endoscopic mucosal resection and the occurrence of AEs or RRAs using mixed-effects logistic regression models (propensity scores). Sensitivity analyses were performed for lesions ≤20 mm or >20 mm.
A total of 290 SNADETs submitted to endoscopic resection during the study period met the inclusion criteria and were analyzed (C-EMR: n = 201, 69.3%; U-EMR: n = 89, 30.7%). The overall technical success rate was 95.5% and comparable between groups. In logistic regression models, compared with U-EMR, C-EMR was associated with a significantly higher frequency of overall delayed AEs (odds ratio [OR], 4.95; 95% CI, 2.87-8.53), postprocedural bleeding (OR, 7.92; 95% CI, 3.95-15.89), and RRAs (OR, 3.66; 95% CI, 2.49-5.37). Sensitivity analyses confirmed these results when solely considering either small (≤20 mm) or large (>20 mm) lesions.
Compared with C-EMR, U-EMR was associated with a lower rate of overall AEs and RRAs, regardless of lesion size. Our results confirm the possible role of U-EMR as an effective and safe technique in the management of SNADETs.
传统内镜黏膜切除术（C-EMR）已成为浅表非壶腹十二指肠上皮肿瘤（SNADETs）的主要治疗方式，但近来水下内镜黏膜切除术（U-EMR）已成为一种潜在的替代方法。以往大多数研究聚焦于亚洲人群和小病灶（≤20mm）。我们旨在比较在西方环境中U-EMR与C-EMR治疗SNADETs的疗效和结果。
这是一项来自10个欧洲中心的回顾性多国研究，这些中心在2013年1月至2023年7月期间开展了C-EMR和U-EMR。主要结局是技术成功率、与手术相关的不良事件（AE）以及残留/复发性腺瘤（RRA）率，按每个病灶进行评估。我们使用混合效应逻辑回归模型（倾向评分）评估内镜黏膜切除术类型与AE或RRA发生之间的关联。对≤20mm或>20mm的病灶进行了敏感性分析。
在研究期间接受内镜切除的290例SNADETs符合纳入标准并进行了分析（C-EMR：n = 201，69.3%；U-EMR：n = 89，30.7%）。总体技术成功率为95.5%，两组之间相当。在逻辑回归模型中，与U-EMR相比，C-EMR与总体延迟AE的发生率显著更高相关（比值比[OR]，4.95；95%置信区间[CI]，2.87 - 8.53）、术后出血（OR，7.92；95% CI，3.95 - 15.89）以及RRA（OR，3.66；95% CI，2.49 - 5.37）。当仅考虑小（≤20mm）或大（>20mm）病灶时，敏感性分析证实了这些结果。
与C-EMR相比，无论病灶大小，U-EMR与总体AE和RRA的发生率较低相关。我们的结果证实了U-EMR作为一种有效且安全的技术在SNADETs管理中的可能作用。
