Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 14, 2019; 25(6): 707-718
Published online Feb 14, 2019. doi: 10.3748/wjg.v25.i6.707
Short- and long-term outcomes of endoscopically treated superficial non-ampullary duodenal epithelial tumors
Yuko Hara, Kenichi Goda, Akira Dobashi, Tomohiko Richard Ohya, Masayuki Kato, Kazuki Sumiyama, Takehiro Mitsuishi, Shinichi Hirooka, Masahiro Ikegami, Hisao Tajiri
Yuko Hara, Akira Dobashi, Tomohiko Richard Ohya, Kazuki Sumiyama, Department of Endoscopy, The Jikei University School of Medicine, Tokyo 105-8461, Japan
Kenichi Goda, Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan
Masayuki Kato, Department of Endoscopy, The Jikei University Katsushika Medical Center, Tokyo 125-8506, Japan
Takehiro Mitsuishi, Shinichi Hirooka, Masahiro Ikegami, Department of Pathology, The Jikei University School of Medicine, Tokyo 105-8461, Japan
Hisao Tajiri, Department of Innovative Interventional Endoscopy Research, The Jikei University School of Medicine, Tokyo 105-8461, Japan
Author contributions: All authors helped to perform the research; Hara Y, Goda K, Dobashi A, and Ohya TR performed the endoscopic procedure; Hara Y and Kato M analyzed and interpreted the data; Hara Y drafted the article; Goda K designed the research; Dobashi A, Ohya TR, Mistuishi T and Hirooka S collected the data; Mistuishi T and Hirooka S performed the pathological diagnosis; Hara Y, Goda K, Sumiyama K, Ikegami M and Tajiri H contributed to critical revision of the article for important intellectual content; Tajiri H provided the final approval for this article.
Institutional review board statement: This study protocol was approved by the Institutional Review Board of the Jikei University School of Medicine, Tokyo, Japan, for clinical research [Registration No.: 29-079 (8695)].
Informed consent statement: This study was a retrospective observational study and carried out by the opt-out method to post a purpose in the Jikei University School of Medicine. Patients were not required to give informed consent for the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent. For full disclosure, the details of the study are mentioned in the opt-put document in the Jikei University School of Medicine.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Yuko Hara, MD, Research Associate, Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi Shinbashi, Minato-ku, Tokyo 105-8461, Japan.
Telephone: +81-3-34331111-3181 Fax: +81-3-34594524
Received: October 13, 2018
Peer-review started: October 14, 2018
First decision: November 7, 2018
Revised: December 31, 2018
Accepted: January 9, 2019
Article in press: January 9, 2019
Published online: February 14, 2019
Research background

Endoscopic resection (ER) for superficial non-ampullary duodenal epithelial tumor (SNADET) is a challenging technique, due to the anatomical peculiarity of the procedure and the high frequency of the adverse event. Moreover, there are few reports on the treatment outcome of ER in many cases because of its relative rarity.

Research motivation

We aimed to determine the standardized criteria for endoscopic management of SNADNETs.

Research objectives

Based on the research background, we analyzed the results of the short-term and long-term treatment of over 100 cases of SNADET and investigated the effectiveness of ER in these cases.

Research methods

This study analyzed the short- and long-term outcomes of ER. Short-term outcomes of ER included en bloc and R0 resection rates, as well as the adverse events. Long-term outcomes included local recurrence detected on endoscopic surveillance and disease-specific mortality in patients followed up for ≥ 12 mo after ER. This retrospective study included a case series of 131 patients (147 SNADETs) who underwent endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) between March 2004 and July 2017.

Research results

Over a median follow-up of 43 mo, recurrence was found in four lesions and those were treated endoscopically. No adverse events were observed in EMR-treated patients, whereas ESD for SNADETs carries a risk of bleeding and perforation. No patient died due to tumor recurrence.

Research conclusions

Our findings suggest that ER provides good long-term outcomes in patients with SNADETs. EMR was not associated with any adverse events and, therefore, could be considered as a standard treatment for small SNADETs.

Research perspectives

For small SNADETs, EMR is likely to become the standard treatment strategy.