Clinical outcomes of endoscopic resection of superficial nonampullary duodenal epithelial tumors: A 10-year retrospective, single-center study

Table 1 Baseline characteristics of the study subjects

Patients	56
Median age, yr (range)	57 (26-77)
Male, n (%)	30 (53.6)
Number of lesions, n (%)
1	54 (96.4)
2	2 (3.6)
Medications, n (%)
Aspirin	3 (5.3)
Clopidogrel	1 (1.8)
Dual antiplatelets	2 (3.6)
Anticoagulants	0
NSAIDs	0
Patients that underwent colonoscopy	39 (69.6)
Colonoscopy positive for adenoma	18 (46.2)
Lesions	58
Location, n (%)
Bulb	9 (15.5)
Second portion	47 (81.0)
Third portion	2 (3.4)
Macroscopic type, n (%)
Ip	10 (17.2)
Is	24 (41.4)
IIa or IIb	24 (41.4)
Biopsy diagnosis, n (%)
Adenoma/LGD	55 (94.8)
Adenoma/HGD	2 (3.4)
Adenocarcinoma	1 (1.7)

NSAID: Nonsteroidal anti-inflammatory drug; LGD: Low-grade dysplasia; HGD: High-grade dysplasia.

Table 2 Endoscopic treatment and complications for the 58 lesions

Treatment methods, n (%)
EMR	57 (98.3)
Snare polypectomy	1 (1.7)
Lesion size, mm, n (%)
Size < 10	20 (34.5)
10 ≤ size < 15	26 (44.8)
15 ≤ size < 20	7 (12.1)
20 ≤ size	5 (8.6)
Results of resection, n (%)
En bloc	39 (67.2)
Piecemeal	19 (32.8)
Adjunctive coagulation, n (%)	29 (50.0)
Prophylactic clip placement, n (%)	48 (82.8)
Complication, n (%)
Intraprocedural bleeding	16 (27.6)
Delayed bleeding	1 (1.7)
Perforation	0 (0)

EMR: Endoscopic mucosal resection.

Table 3 Histopathologic results for the 58 lesions

Tumor size, mm, median (range)	12 (4–20)
Final pathology, n (%)	57 (98.3)
Adenoma/LGD	52 (89.7)
Adenoma/HGD	3 (5.2)
Intramucosal adenocarcinoma	3 (5.2)
Lateral margin, n (%)
Negative	36 (62.1)
Positive	3 (5.2)
Inconclusive	19 (32.8)
Vertical margin, n (%)
Negative	50 (86.2)
Positive	0 (0)
Inconclusive	8 (13.8)
Complete (R0) resection	36 (62.1)

LGD: Low-grade dysplasia; HGD: High-grade dysplasia.

Table 4 Factors associated with endoscopic mucosal resection -related bleeding

	Bleeding (+) (n = 17)	Bleeding (-) (n = 41)	P value
Antiplatelet use			0.661
Yes	1 (14.3)	6 (85.7)
No	16 (31.4)	35 (68.6)
Lesion size, mm, n (%)			0.033
Size < 10	1 (5.0)	19 (95.0)
10 ≤ size < 15	8 (30.8)	18 (69.2)
15 ≤ size < 20	4 (57.1)	3 (42.9)
20 ≤ size	4 (80.0)	1 (20.0)
Results of resection, n (%)			0.218
En bloc	9 (23.1)	30 (76.9)
Piecemeal	8 (42.1)	11 (57.9)
Location, n (%)			0.855
Bulb	2 (22.2)	7 (77.8)
Second portion	15 (31.9)	32 (68.1)
Third portion	0 (0)	2 (100)
Macroscopic type, n (%)			0.950
Ip	2 (20.0)	8 (80.0)
Is	7 (29.2)	17 (70.8)
IIa or IIb	8 (33.3)	16 (66.7)
Final pathology			0.345
Adenoma/LGD	14 (26.9)	38 (73.1)
Adenoma/HGD and adenocarcinoma	3 (50.0)	3 (50.0)

LGD: Low-grade dysplasia; HGD: High-grade dysplasia

Table 5 Clinicopathologic data and outcomes for 3 cases of incomplete resection

Patient	Age (yr)	Location	Tumor Size	Pathology	Resection type	Treatment method	Vertical/lateral margin	Result of follow-up biopsy	Follow-up (mo)
1	72	Bulb	20	Intramucosal adenocarcinoma	En bloc	EMR	-/+	-	29
2	71	Bulb	20	LGD	En bloc	EMR	-/+	-	27
3	75	2nd portion	10	LGD	En bloc	EMR	-/+	-	17

LGD: Low-grade dysplasia; EMR: Endoscopic mucosal resection.

Table 6 Long-term outcomes (n = 50 patients and 52 lesions)

Recurrence, n (%)	0 (0%)
Death by duodenal neoplasm	0 (0%)
All-cause mortality	2 (3.6%)
Follow-up period median (range)	23 (6-100) mo
No. of follow-up endoscopies
2	9
3 or 4	28
5 ≤	13