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

医学 粘膜切除术 外科 息肉切除术 随机对照试验 切除术 内科学 癌症 结直肠癌 结肠镜检查
作者
Kurato Miyazaki,Atsushi Nakayama,Motoki Sasaki,Daisuke Minezaki,Kohei Morioka,Kentarô Iwata,Teppei Masunaga,Yoko Kubosawa,Mari Mizutani,Yukie Hayashi,Yoshiyuki Kiguchi,Teppei Akimoto,Yusaku Takatori,Shintaro Kawasaki,Noriko Matsuura,Tomohisa Sujino,Kaoru Takabayashi,Kazuhiro Yamanoi,Keita Mori,Takanori Kanai∥
出处
期刊:The American Journal of Gastroenterology [Lippincott Williams & Wilkins]
卷期号:119 (5): 856-863 被引量:9
标识
DOI:10.14309/ajg.0000000000002634
摘要

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.
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