Short- and long-term outcomes of endoscopically treated superficial non-ampullary duodenal epithelial tumors

Table 1 Characteristics of patients and tumors

Patients, n = 131		Value
Male, n (%)		94 (72)
Age, median (IQR), yr		64 (57-70)
Tumors, n = 147		Value
Location, n
	First/second/third or fourth	19/90/38
	Tumor diameter, median (IQR), mm	10 (7-15)
Macroscopic type1, n
	0-I / 0-IIa / 0-IIc	30/61/56
Treatment, n
	EMR/ESD	136/11
Histology, n
	LGIN/HGIN/MC/SMC	47/44/54/2

¹Predominant macroscopic type.

IQR: Interquartile range; EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection; LGIN: Low-grade intraepithelial neoplasia; HGIN: High-grade intraepithelial neoplasia; MC: Mucosal carcinoma; SMC: Submucosal carcinoma.

Table 2 Long-term outcomes of endoscopic resection for 121 patients with 135 superficial non-ampullary duodenal epithelial tumors

		Value
Follow-up period
	Median (IQR), mo	43 (24-60)
Local recurrence, n (%)
	≤ 12 mo3	4 (3)1
	> 12 mo4	0
Prognosis
	Death by duodenal tumor, n	0
	Death by other causes, n (%)	1 (0.9)2

IQR, interquartile range.

¹Detail is provided in Table 3.

²Death by cardiac failure.

³Within 12 mo after endoscopic resection.

⁴More than 12 mo after endoscopic resection.

Table 3 Characteristics of recurrence cases after endoscopic resection

	Location	Diameter (mm)	Macroscopic type	Treatment	En bloc/Piecemeal (n)	R0 status	Histology
1	Second	8	0-IIc	EMR-C	En bloc	RX	MC	HMX	VM0
2	Second	18	0-IIc	EMR-C	Piecemeal (3)	RX	MC	HMX	VM0
3	Second	18	0-IIa	EMR-C	Piecemeal (2)	RX	HGIN	HMX	VM0
4	Second	25	0-IIa	EMR-S	En bloc	R1	HGIN	HM1	VM0

EMR-C: Cap-assisted endoscopic mucosal resection; EMR-S: Conventional method with a snare; MC: Mucosal carcinoma; HGIN: High-grade intraepithelial neoplasia; RX: Involvement of the horizontal and/or vertical margin could not be assessed histopathologically; R1: Involvement of the horizontal and/or vertical margin histopathologically; HMX: Involvement of the horizontal margin could not be assessed histopathologically; HM1: Involvement of the horizontal margin histopathologically; VM0: No involvement of the vertical margin histopathologically.

Table 4 Short-term outcomes and adverse events (EMR-S vs EMR-C)

Outcome			EMR-S, n = 82	EMR-C, n = 54	P-value
Macroscopic type; 0-I or 0-IIa/0-IIc			67 (82)/15 (18)	14 (26)/40 (74)	< 0.001
En bloc resection			73 (89)	48 (89)	NS
R0 resection			51 (62)	42 (78)	NS
Success rate of clip closure			80 (98)	52 (96)	NS
Adverse events			0	0	NA
	Perforation
		Intraoperative	0	0	NA
		Delayed	0	0	NA
	Delayed bleeding		0	0	NA

Data are presented as n (%). EMR-S: Conventional endoscopic mucosal resection using a snare; EMR-C: Cap-assisted endoscopic mucosal resection; NS: Not significant; NA: Not available.

Table 5 Short-term outcomes and adverse events (endoscopic mucosal resection vs endoscopic submucosal dissection)

Outcome			EMR, n = 136	ESD, n = 11	P-value
Tumor diameter, median (IQR)			9 (7-14.5)	20 (15-33)	< 0.001
Macroscopic type; 0-I or 0-IIa/0-IIc			81 (60)/55 (40)	10 (91)/1 (9)	NS
En bloc resection			121 (89)	11 (100)	NS
R0 resection			93 (68)	8 (73)	NS
Success rate of defect closure			132 (97)	7 (64)	< 0.001
Adverse events			0	5 (45)	< 0.001
	Perforation
		Intraoperative	0	3 (27)1	< 0.001
		Delayed	0	2 (18)2	0.004
	Delayed bleeding		0	1 (9)2	NS

Data are presented as n (%).

¹One required surgery, two recovered with conservative treatment.

²Recovered with conservative treatment.

EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection; NS: Not significant; IQR: Interquartile range.