Selection of appropriate endoscopic therapies for duodenal tumors: An open-label study, single-center experience

摘要

AIM:To determine an appropriate compartmentalization of endoscopic submucosal dissection(ESD)or endoscopic mucosal resection(EMR)for duodenal tumors.METHODS:Forty-six duodenal lesions(excluding papillary lesions)from 44 patients with duodenal tumors treated endoscopically between 2005 and 2013 were divided into the ESD and EMR groups for retrospective comparison and analysis.RESULTS:The mean age was 65±9 years(35-79years).There were 24 lesions from men and 22 from women.The lesions consisted of 6 early cancers,31adenomas and 9 neuroendocrine tumors.Lesion location was the duodenal bulb in 15 cases and the descending part of the duodenum in 31 cases.The most common macroscopic morphology was elevated type in 21 cases(45.6%).Mean tumor diameter was 11.9±9.7 mm(3-60 mm).Treatment procedure was ESD(15 cases)vs EMR(31 cases).The examined parameters in the ESD vs EMR groups were as follows:mean tumor diameter,12.9±14.3 mm(3-60 mm)vs 11.4 ±6.7 mm(4-25 mm);en bloc resection rate,86.7%vs 83.9%;complete resection rate,86.7%vs 74.2%;procedure time,86.5±63.1 min(15-217 min)vs 13.2±17.0 min(2-89 min)(P<0.0001);intraprocedural perforation,3 cases vs none(P=0.0300);delayed perforation,none in either group;postprocedural bleeding,1 case vs none;mean postoperative length of hospitalization,8.2±2.9 d(5-16 d)vs 6.1±2.0 d(2-12 d)(P=0.0067);recurrence,none vs 1 case(occurring at 7 mo postoperatively).CONCLUSION:ESD was associated with a longer procedure time and a higher incidence of intraprocedural perforation;EMR was associated with a lower rate of complete resection.