title: Therapeutic outcomes of endoscopic resection for superficial non-ampullary duodenal tumor.
abstract: OBJECTIVE
  Endoscopic resection (ER) is widely used as a minimally invasive therapy to remove superficial non-ampullary duodenal tumor (SNADT). However, the indication criteria have not yet been clearly determined. At our institute, ER is done only for SNADT measuring ≤ 20 mm. We report our findings on the therapeutic outcomes of ER of SNADT.
  
  
  METHODS
  We carried out ER in 47 patients with SNADT. Indication criteria for ER included a lesion suspected as high-grade dysplasia or mucosal cancer and measuring ≤ 20 mm. The ER methods used to carry out en bloc resection were endoscopic mucosal resection (EMR: 17 lesions) or endoscopic submucosal dissection (ESD: 30 lesions). We then analyzed the therapeutic outcomes between them.
  
  
  RESULTS
  There were no significant differences between the EMR and ESD groups with regard to age, sex, location of the lesion, and histology. The most frequent gross types resected by EMR and ESD were 0-IIa and 0-IIc, respectively (P=0.004). Median procedure time was significantly longer in ESD than in EMR, 79.5 and 9 min, respectively (P<0.001). R0 resection was achieved in 10 cases by EMR (59%) and in 27 cases by ESD (90%) (P=0.017). No complications occurred in cases that underwent EMR, but immediate and delayed perforations occurred in three patients who underwent ESD, although this difference was not statistically significant (P=0.467).
  
  
  CONCLUSIONS
  Using our indication criteria, which limited lesion size to ≤ 20 mm, satisfactory therapeutic outcomes of ER of SNADT were obtained.
authors.affiliation: Division of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan.
authors.forename: Yorimasa
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Natsuko
authors.initials: N
authors.lastname: Yoshizawa
authors.forename: Hideomi
authors.initials: H
authors.lastname: Tomida
authors.forename: Junko
authors.initials: J
authors.lastname: Fujisaki
authors.forename: Masahiro
authors.initials: M
authors.lastname: Igarashi
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery*; D000368:Aged; D014670:Ampulla of Vater; D015331:Cohort Studies; D018572:Disease-Free Survival; D004379:Duodenal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D004384:Duodenoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging; D061646:Operative Time; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome
keywords: delayed perforation; endoscopic mucosal resection (EMR); endoscopic submucosal dissection (ESD); superficial non-ampullary duodenal tumor (SNADT); therapeutic outcome