title: Endoscopic resection for duodenal subepithelial tumors: a single-center experience.
abstract: Subepithelial tumors (SETs) in the gastrointestinal tract are often incidentally found during endoscopic examinations. Although the utility and safety of endoscopic resection (ER) of SETs in the esophagus and stomach have been described, data about the ER of duodenal SETs remain scant. Therefore, we aimed to investigate the clinical outcomes associated with the ER of duodenal SETs and to assess possible predictive factors for incomplete resection.
  
  
  
  We conducted a retrospective observational study of 62 patients (64 lesions) that underwent ER of duodenal SETs between June 2005 and December 2015 at the Pusan National University Hospital. The therapeutic outcomes from ER and procedure-related complications were analyzed.
  
  
  
  Endoscopic mucosal resection (EMR) was performed in 38 tumors, EMR with a ligation device (EMR-L) in 18 and endoscopic submucosal dissection (ESD) in 8. The overall en bloc resection and complete ER rates were 96.9 % (62/64) and 100 % (64/64), respectively. The complete pathologic resection rate was 76.6 % (49/64). Multivariate logistic regression analyses determined that the macroscopic type (Yamada type I or II; odds ratio [OR] 6.460, 95 % confidence interval [CI] 1.569-37.458, p = 0.027) and the treatment method (ESD; OR 7.178, 95 % CI 1.291-39.323, p = 0.024) were independently associated with incomplete pathologic resection. The procedure-related bleeding and perforation rates were 6.3 % and 4.7 %, respectively. No recurrences were observed in patients who had undergone complete ER at a median follow-up period of 20 months (range 6-112 months).
  
  
  
  ER is an effective, safe, and feasible treatment for duodenal SETs, especially when the SET is located in the deep mucosal layer and/or the submucosal layer.
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, 179, Gudeok-ro, Seo-Gu, Busan, 49241, Korea.
authors.forename: Tae Wook
authors.initials: TW
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, 179, Gudeok-ro, Seo-Gu, Busan, 49241, Korea. doc0224@pusan.ac.kr.|Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-ro, Seo-Gu, Busan, 49241, Korea. doc0224@pusan.ac.kr.
authors.forename: Gwang Ha
authors.initials: GH
authors.lastname: Kim
authors.affiliation: Department of Pathology, Pusan National University School of Medicine, 179, Gudeok-ro, Seo-Gu, Busan, 49241, Korea.
authors.forename: Do Youn
authors.initials: DY
authors.lastname: Park
authors.affiliation: Department of Pathology, Pusan National University School of Medicine, 179, Gudeok-ro, Seo-Gu, Busan, 49241, Korea.
authors.forename: Sangjeong
authors.initials: S
authors.lastname: Ahn
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, 179, Gudeok-ro, Seo-Gu, Busan, 49241, Korea.
authors.forename: Won
authors.initials: W
authors.lastname: Lim
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, 179, Gudeok-ro, Seo-Gu, Busan, 49241, Korea.
authors.forename: Bon Eun
authors.initials: BE
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, 179, Gudeok-ro, Seo-Gu, Busan, 49241, Korea.
authors.forename: Geun Am
authors.initials: GA
authors.lastname: Song
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D004379:Duodenal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D000069916:Endoscopic Mucosal Resection / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000379:methods*; D019160:Endosonography; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology; D006801:Humans; D007416:Intestinal Perforation / Q000453:epidemiology; D008067:Lipoma / Q000473:pathology / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D018365:Neoplasm, Residual; D018358:Neuroendocrine Tumors / Q000473:pathology / Q000601:surgery*; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Duodenum; Endoscopic resection; Subepithelial tumor