Journal Article

Resectability of Small Duodenal Tumors: A Randomized Controlled Trial Comparing Underwater Endoscopic Mucosal Resection and Cold Snare Polypectomy

Keita Mori, Teppei Masunaga, Teppei Akimoto, Mari Mizutani, Yukie Hayashi, Yusaku Takatori, Motoki Sasaki, Tomohisa Sujino, Kazuhiro Yamanoi, Noriko Matsuura, Yoshiyuki Kiguchi, Kohei Morioka, Kurato Miyazaki, Motohiko Kato, Shintaro Kawasaki, Kaoru Takabayashi, Takanori Kanai, Daisuke Minezaki, Kentaro Iwata, Yoko Kubosawa, Atsushi Nakayama, Naohisa Yahagi

2024

Overview

INTRODUCTION:Underwater endoscopic mucosal resection (UEMR) and cold snare polypectomy (CSP) are novel endoscopic procedures for superficial nonampullary duodenal epithelial tumors (SNADET). However, consensus on how to use both procedures appropriately has not been established. In this study, we evaluated treatment outcomes of both procedures, including resectability.METHODS:In this single-center randomized controlled study conducted between January 2020 and June 2022, patients with SNADET ≤12 mm were randomly allocated to UEMR and CSP groups. The primary end point was sufficient vertical R0 resection (SVR0), which was defined as R0 resection including a sufficient submucosal layer. We compared treatment outcomes including SVR0 rate between groups.RESULTS:The SVR0 rate was significantly higher in the UEMR group than in the CSP group (65.6% vs 41.5%, P = 0.01). By contrast, the R0 resection rate was not significantly different between study groups (70.3% vs 61.5%, P = 0.29). The submucosal layer thickness was significantly greater in the UEMR group than in the CSP group (median 546 [range, 309-833] μm vs 69 [0-295] μm, P < 0.01). CSP had a shorter total procedure time (median 12 [range, 8-16] min vs 1 [1-3] min, P < 0.01) and fewer total bleeding events (9.4% vs 1.5%, P = 0.06).DISCUSSION:UEMR has superior vertical resectability compared with CSP, but CSP has a shorter procedure time and fewer bleeding events. Although CSP is preferable for most small SNADET, UEMR should be selected for lesions that cannot be definitively diagnosed as mucosal low-grade neoplasias.

• Publisher: Ovid Technologies (Wolters Kluwer Health),Wolters Kluwer,Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
• Subject: Adult / Aged / Aged, 80 and over / Biopsy / Cancer / Clinical trials / Duodenal Neoplasms - pathology / Duodenal Neoplasms - surgery / Duodenoscopy - methods / Endoscopic Mucosal Resection - methods / Endoscopy / Female / Genotype & phenotype / Humans / Intestinal Mucosa - pathology / Intestinal Mucosa - surgery / Intestinal Polyps - pathology / Intestinal Polyps - surgery / Male / Middle Aged / Patients / Performance evaluation / Treatment Outcome / Tumors