Yahagi Naohisa, Takatori Yusaku, Sasaki Motoki, Imura Yuri, Murata Shoma, Sato Tsubasa, Minezaki Daisuke, Hayakawa Takaoki, Nakajima Yuki, Okada Haruka, Sakurai Hinako, Tojo Anna, Iwata Kentaro, Miyazaki Kurato, Kayashima Atsuto, Masunaga Teppei, Mizutani Mari, Akimoto Teppei, Seino Takashi, Kawasaki Shintaro, Horibe Masayasu, Fukuhara Seichiro, Matsuura Noriko, Sujino Tomohisa, Nakayama Atsushi, Takabayashi Kaoru, Iwasaki Eisuke, Kato Motohiko
Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
Dig Endosc. 2025 Apr;37(4):402-410. doi: 10.1111/den.14942. Epub 2024 Nov 3.
Endoscopic papillectomy (EP) is a low-invasive treatment for duodenal tumors including papilla. The limit of lesion size and local recurrence have been issues in EP. We developed endoscopic submucosal dissection (ESD) for the duodenal tumors including papilla (ESDIP: ESD including papilla) to overcome the problems. The aim of this study was to evaluate the feasibility of ESDIP.
We included the patients who underwent ESDIP from August 2010 to January 2024 in this study. We evaluated the retrospective characteristics of patients and lesions, clinical results of ESDIP and of endoscopic retrograde cholangiopancreatography (ERCP) as prevention for delayed adverse events, and pathological findings. We also calculated the cumulative recurrence rate and overall survival rate at 12 months after ESDIP.
Fifty-four patients were included in this study. The mean lesion size was 39 mm. The third-quarter cases revealed a less than half-circumferential lesion, and the one case with a full-circumferential lesion. Resection was accomplished in 96% (n = 52), and also the en-bloc resection rate was 96%. Of the cases in accomplished resection, 98% of patients were intubated with a pancreaticobiliary drainage tube by ERCP. Intraprocedural perforation occurred in eight cases. Delayed bleeding occurred in 10 cases. Delayed perforation was seen only in one case. The incidence of post-ERCP pancreatitis was 25%. Cumulative local recurrence rate and the overall survival rate were 15% and 96%, respectively.
ESDIP may be feasible for duodenal tumors including papilla, and is a potential alternative option to avoid pancreaticoduodenectomy.
