Tashima Tomoaki, Dohi Osamu, Kobara Hideki, Kawasaki Tomonori, Fukui Hayato, Tada Naoya, Uchita Kunihisa, Asai Satoshi, Hirose Takashi, Muramatsu Takahiro, Ishikawa Tsubasa, Ryozawa Shomei
Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan.
Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Kyoto, Japan.
J Gastroenterol Hepatol. 2025 Aug;40(8):2018-2027. doi: 10.1111/jgh.17005. Epub 2025 May 23.
Resection of non-ampullary duodenal neuroendocrine tumors presents technical challenges. This study investigated the efficacy and safety of endoscopic mucosal resection using an over-the-scope clip compared to endoscopic mucosal resection with a ligation device and endoscopic submucosal dissection.
This retrospective multicenter study included 65 lesions (63 patients), categorized by resection method: endoscopic mucosal resection using an over-the-scope clip (n = 26), endoscopic mucosal resection using a ligation device (n = 17), and endoscopic submucosal dissection (n = 22). Patient characteristics, tumor details, and outcomes were systematically evaluated, with significance at p < 0.05.
Endoscopic mucosal resection using an over-the-scope clip had a significantly shorter procedure time than endoscopic submucosal dissection (16 min [7-30] vs. 60 min [28-119], p < 0.001) and recorded no perforations. Endoscopic mucosal resection using a ligation device was employed for smaller lesions, while endoscopic submucosal dissection had challenges in achieving clear margins. Hospitalization duration was the longest for the endoscopic submucosal dissection group (endoscopic mucosal resection using an over-the-scope clip: 4 [3-7] days, endoscopic mucosal resection using a ligation device: 5 [4-8] days, endoscopic submucosal dissection: 7 [4-15] days, p < 0.001). Endoscopic mucosal resection using an over-the-scope clip exhibited a unique advantage for full-thickness resection.
Endoscopic mucosal resection using an over-the-scope clip allows for full-thickness resection with fewer complications. While effective, endoscopic mucosal resection using a ligation device is less reliable for achieving clear vertical margins, and endoscopic submucosal dissection, suitable for larger tumors, has a longer duration and higher complication rate.
非壶腹十二指肠神经内分泌肿瘤的切除存在技术挑战。本研究比较了使用套扎器的内镜黏膜切除术与使用结扎装置的内镜黏膜切除术及内镜黏膜下剥离术的疗效和安全性。
这项回顾性多中心研究纳入了65个病变（63例患者），根据切除方法分类：使用套扎器的内镜黏膜切除术（n = 26）、使用结扎装置的内镜黏膜切除术（n = 17）和内镜黏膜下剥离术（n = 22）。系统评估了患者特征、肿瘤细节和结果，p < 0.05具有统计学意义。
使用套扎器的内镜黏膜切除术的手术时间明显短于内镜黏膜下剥离术（16分钟[7 - 30] vs. 60分钟[28 - 119]，p < 0.001），且未发生穿孔。使用结扎装置的内镜黏膜切除术用于较小的病变，而内镜黏膜下剥离术在获得切缘阴性方面存在挑战。内镜黏膜下剥离术组的住院时间最长（使用套扎器的内镜黏膜切除术：4[3 - 7]天，使用结扎装置的内镜黏膜切除术：5[4 - 8]天，内镜黏膜下剥离术：7[4 - 15]天，p < 0.001）。使用套扎器的内镜黏膜切除术在全层切除方面具有独特优势。
使用套扎器的内镜黏膜切除术可实现全层切除且并发症较少。使用结扎装置的内镜黏膜切除术虽然有效，但在获得清晰的垂直切缘方面可靠性较低，而适用于较大肿瘤的内镜黏膜下剥离术持续时间更长且并发症发生率更高。
