Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.
Digestive Endoscopy Centre, Fujian Provincial Hospital, Fuzhou, China.
Int J Colorectal Dis. 2024 Jul 31;39(1):122. doi: 10.1007/s00384-024-04698-5.
This study aimed to assess the safety and efficacy of endoscopic submucosal dissection (ESD) and pre-cutting endoscopic mucosal resection (pEMR) in treating non-ampullary duodenal subepithelial lesions (NADSELs) and to evaluate the clinical utility of endoscopic ultrasound (EUS) before endoscopic resection (ER).
In this retrospective single-centre cohort study, we compared the clinical outcomes of patients with NADSELs who underwent ESD or pEMR between January 2014 and June 2023. The accuracies of EUS in determining the pathological type and origin of the lesions were evaluated using postoperative histopathology as the gold standard.
Overall, 56 patients with NADSELs underwent ER in this study, including 16 and 40 treated with pEMR and ESD, respectively. There were no significant differences between the two groups in terms of en bloc resection rate, complete (R0) resection rate, perioperative complication rate, and postoperative hospital length of stay (P > 0.05). However, the pEMR group had significantly shorter median operational (13.0 min vs. 30.5 min, P < 0.001) and mean fasting (1.9 days vs. 2.8 days, P = 0.006) time and lower median hospital costs (¥12,388 vs. ¥19,579, P = 0.002). The accuracies of EUS in determining the pathological type and origin of the lesions were 76.8% and 94.6%, respectively, compared with histopathological evaluation.
EUS can accurately predict the origin of NADSELs. Suitable lesions determined to originate from the submucosa or more superficial layers using EUS can be treated using pEMR as it shortens the operational and recovery time, reduces hospitalisation costs, and achieves an R0 resection rate similar to ESD.
本研究旨在评估内镜黏膜下剥离术（ESD）和预切开内镜黏膜切除术（pEMR）治疗非壶腹十二指肠黏膜下病变（NADSELs）的安全性和有效性，并评价内镜超声（EUS）在内镜切除（ER）前的临床应用价值。
本回顾性单中心队列研究比较了 2014 年 1 月至 2023 年 6 月期间接受 ESD 或 pEMR 治疗的 NADSEL 患者的临床结局。以术后组织病理学为金标准，评估 EUS 确定病变病理类型和起源的准确性。
本研究共纳入 56 例 NADSEL 患者行 ER，其中 16 例行 pEMR，40 例行 ESD。两组整块切除率、完全（R0）切除率、围手术期并发症发生率和术后住院时间（P>0.05）差异无统计学意义。然而，pEMR 组的中位手术时间（13.0 分钟比 30.5 分钟，P<0.001）和平均禁食时间（1.9 天比 2.8 天，P=0.006）更短，中位住院费用（¥12388 比 ¥19579，P=0.002）更低。EUS 确定病变病理类型和起源的准确性分别为 76.8%和 94.6%，与组织病理学评估相比。
EUS 能准确预测 NADSELs 的起源。对于 EUS 确定起源于黏膜下层或更浅层的合适病变，可采用 pEMR 治疗，可缩短手术和恢复时间，降低住院费用，且达到与 ESD 相似的 R0 切除率。
