Short- and long-term outcomes after endoscopic resection of sporadic nonampullary duodenal tumors: An 11-year single-center retrospective study

Figure 1 Endoscopic mucosal resection for sporadic nonampullary duodenal tumor. 0-IIc lesion, 6 mm × 5 mm, tubular adenoma, vertical margin (-), horizontal margin (-). A: Lesion in the descending duodenum; B: Indigo carmine delineated margins; C: Submucosal methylene blue saline injection; D: Snare ligation; E: Post- endoscopic mucosal resection ulcer; F: Complete clip closure.

Figure 2 Endoscopic submucosal dissection for sporadic nonampullary duodenal tumor. 0-IIa lesion, 15 mm × 10 mm, mucosal carcinoma, vertical margin (-), horizontal margin (-). A: Lesion in the descending duodenum; B: Narrow band imaging revealed irregular microvascular and microsurface patterns; C: Injection after marking; D and E: Circumferential incision and submucosal dissection with golden knife; F: Post-endoscopic submucosal dissection ulcer; G: Clip closure; H: En bloc specimen.

Figure 3 Endoscopic submucosal dissection for sporadic nonampullary duodenal tumor. Submucosal tumor, 10 mm × 6 mm, neuroendocrine tumor G1, vertical margin (-), horizontal margin (-). A: Lesion in the bulb; B: Micro-probe endoscopic ultrasonography showed a hypoechoic lesion in the second layer; C: Marking; D and E: Dissection with golden knife; F: Post-endoscopic submucosal dissection ulcer; G: Clip closure; H: En bloc specimen.

Figure 4 Endoscopic submucosal dissection with snare for sporadic nonampullary duodenal tumor. 0-IIa lesion, 12 mm × 8 mm, high-grade intraepithelial neoplasia, vertical margin (-), horizontal margin (-). A: Lesion in the descending duodenum; B: Narrow band imaging abnormalities; C: Indigo carmine delineation; D: Submucosal dissection until most of the lesion was freed; E: Final snare excision; F: Post-endoscopic submucosal dissection with snare ulcer; G: Clip closure; H: En bloc specimen.

Figure 5 Study flowchart and clinical outcomes. EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection; ESD-S: Endoscopic submucosal dissection with snare; FAP: Familial adenomatous polyposis.

Figure 6 En bloc and complete resection rates across endoscopic resection groups. EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection; ESD-S: Endoscopic submucosal dissection with snare.

Figure 7  Effect of en bloc resection on complete resection rate.