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Endoscopic resection for duodenal subepithelial tumors: a single-center experience

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Abstract

Background

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.

Methods

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.

Results

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).

Conclusion

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.

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Acknowledgments

This study was supported by a grant from the National R&D Program for Cancer Control, Ministry for Health, Welfare and Family Affairs, Republic of Korea (0920050) and by the Medical Research Center Program through the National Research Foundation of Korea grant funded by the Korea government (NRF-2015R1A5A2009656).

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Authors and Affiliations

  1. Department of Internal Medicine, Pusan National University School of Medicine, 179, Gudeok-ro, Seo-Gu, Busan, 49241, Korea

    Tae Wook Kim, Gwang Ha Kim, Won Lim, Bon Eun Lee & Geun Am Song

  2. Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-ro, Seo-Gu, Busan, 49241, Korea

    Gwang Ha Kim

  3. Department of Pathology, Pusan National University School of Medicine, 179, Gudeok-ro, Seo-Gu, Busan, 49241, Korea

    Do Youn Park & Sangjeong Ahn

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  1. Tae Wook Kim
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Correspondence to Gwang Ha Kim.

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Disclosures

Tae Wook Kim, Gwang Ha Kim, Do Youn Park, Sangjeong Ahn, Won Lim, Bon Eun Lee, and Geun Am Song have no conflict of interest or financial ties to disclose.

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Kim, T.W., Kim, G.H., Park, D.Y. et al. Endoscopic resection for duodenal subepithelial tumors: a single-center experience. Surg Endosc 31, 1936–1946 (2017). https://doi.org/10.1007/s00464-016-5200-7

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