title: Endoscopic Submucosal Dissection and Endoscopic Mucosal Resection for Non-Ampullary Superficial Duodenal Tumor.
abstract: BACKGROUND
  Endoscopic submucosal resection (ESD) and endoscopic mucosal resection (EMR) are well established as curable and safety procedures for treating superficial tumors of the stomach, esophagus and colon. However, a majority of endoscopic resection strategies for non-ampullary superficial duodenal tumors (NASDTs) remains undefined. The aim of this study was to clarify which was the right method for NASDT treatment - EMR or ESD.
  
  
  CONCLUSIONS
  We analyzed 129 consecutive endoscopic resection (74 ESD and 55 EMR) procedures performed with NADSTs and divided the ESD group into 49 large ESD groups (more than 20 mm in diameter) and 25 small ESD groups (less than 20 mm in diameter). With respect to the technical outcomes of EMR/ESD for small size NASDTs, EMR was safer than ESD, but its nature of curability was inferior to that of ESD. The rates of complication such as perforation or delayed bleeding were significantly higher in both ESD groups than in the EMR group. However, the prophylactic endoscopic closure of large mucosal defects after ESD was useful for resolving those complications. The limitations of our study were involvement of a single-center, limited sample size, short follow-up duration and the retrospective design, which may have introduced selection bias. However, the present findings suggest that adequate endoscopic treatment strategy for NASDTs can lead to favorable outcomes and an excellent prognosis. Key Message: It is necessary to select EMR or ESD adequately for R0 resection of small NASDTs, according to their size and location. For large NASDTs, duodenal ESD with essential management is feasible and useful as a therapeutic procedure.
authors.affiliation: Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
authors.forename: Shu
authors.initials: S
authors.lastname: Hoteya
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Furuhata
authors.forename: Toba
authors.initials: T
authors.lastname: Takahito
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Fukuma
authors.forename: Yugo
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kikuchi
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Mitani
authors.forename: Akira
authors.initials: A
authors.lastname: Matsui
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamashita
authors.forename: Kosuke
authors.initials: K
authors.lastname: Nomura
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Kuribayashi
authors.forename: Toshiro
authors.initials: T
authors.lastname: Iizuka
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Kaise
mesh_terms: D004210:Dissection / Q000379:methods*; D004379:Duodenal Neoplasms / Q000473:pathology / Q000601:surgery*; D004386:Duodenum / Q000473:pathology / Q000601:surgery; D000069916:Endoscopic Mucosal Resection / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome