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  • Georg Thieme Verlag KG  (2)
  • 2015-2019  (2)
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  • Georg Thieme Verlag KG  (2)
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  • 2015-2019  (2)
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  • 1
    Online Resource
    Online Resource
    Comparative analysis of ESD versus EMR in a large European series of non-ampullary superficial duodenal tumors
    Georg Thieme Verlag KG ; 2018
    In:  Endoscopy International Open Vol. 06, No. 08 ( 2018-08), p. E1008-E1014
    Details
    In: Endoscopy International Open, Georg Thieme Verlag KG, Vol. 06, No. 08 ( 2018-08), p. E1008-E1014
    Abstract: Background and study aims The choice of endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) in non-ampullary superficial duodenal tumors (NASDTs) is challenging and the benefits of ESD remain unclear. The aim was to comparatively analyze the feasibility, outcomes and safety of these techniques in these lesions. Patients and methods This is an observational and retrospective study. All consecutive patients presenting with NASDTs who underwent EMR or ESD between 2005 and 2017 were included. The following main outcomes were comparatively evaluated: en-bloc and complete (R0) resection rates, and local recurrence. Secondary outcomes were perforation and delayed bleeding. Results One hundred sixty-six tumors in 150 patients (age: 66 years, range: 31 – 83, 42.7 % males) were resected by ESD (n = 37) or EMR (n = 129) and included. The median procedure time (81 vs. 50 min, P = 0.007) and tumor size (25 vs. 20 mm, P = 0.01) were higher in the ESD group. The global malignancy rate was 50.3 %. There were no differences in en-bloc resection (29.7 % vs. 44.2 %, P = 0.115), complete resection (19.4 % vs. 35.5 %, P = 0.069), and local recurrence (14.7 % vs. 16.7 %, P = 0.788) rates. Tumor size was associated with recurrence (28 vs. 20 mm, P = 0.008), with a median follow-up of 6.5 months. Focal recurrence (n = 22, 13.3 %) was treated endoscopically in 86.4 %. En-bloc resection in the ESD group was comparable in large ( ≥ 20 mm) and small lesions (27.6 % vs. 37.5 %, P = 0.587), while this outcome decreased significantly in large lesions resected by EMR (17.4 % vs. 75 %, P  〈  0.001). Nine perforations were confirmed in 6 lesions (16.2 %) resected by ESD and 3 (2.3 %) by EMR (P = 0.001). Endoscopic therapy was successful in all but 1 patient (88.9 %) presenting with a delayed perforation. Conclusions ESD may be an alternative to EMR and surgery in selected NASDTs, such as large duodenal tumors where EMR achieves low en-bloc resection rates and the local recurrence may be higher. However, this technique may have a higher risk of perforations.
    Type of Medium: Online Resource
    ISSN: 2364-3722 , 2196-9736
    URL: Article
    DOI: 10.1055/a-0577-7546
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2018
    detail.hit.zdb_id: 2761052-4
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  • 2
    Online Resource
    Online Resource
    ESD versus EMR in non-ampullary superficial duodenal tumors: a systematic review and meta-analysis
    Georg Thieme Verlag KG ; 2018
    In:  Endoscopy International Open Vol. 06, No. 08 ( 2018-08), p. E998-E1007
    Details
    In: Endoscopy International Open, Georg Thieme Verlag KG, Vol. 06, No. 08 ( 2018-08), p. E998-E1007
    Abstract: Background and study aims Endoscopic submucosal dissection (ESD) has been developed as an option for treatment of esophageal, gastric and colorectal lesions. However, there is no consensus on the role of ESD in duodenal tumors. Methods This systematic review and meta-analysis compared ESD and endoscopic mucosal resection (EMR) in sporadic non-ampullary superficial duodenal tumors (NASDTs), including local experience. We conducted a search in PubMed, Scopus and the Cochrane library up to August 2017 to identify studies that compared both techniques reporting at least one main outcome (en-bloc/complete resection, local recurrence). Pooled outcomes were calculated under fixed and random-effect models. Subgroup analyses were conducted. Results A total of 753 patients presenting with 784 NASDTs (242 ESD, 542 EMR) in 14 studies were included. Tumor size (MD: 5.88, [CI95 %: 2.15, 9.62] , P = 0.002, I2 = 79 %) and procedure time (MD: 65.65, [CI95 %: 40.39, 90.92], P  〈  0.00001, I2 = 88 %) were greater in the ESD group. En-bloc resection rate was significantly higher in Asian studies (OR: 2.16 [CI95 %: 1.15, 4.08], P = 0.02, I2: 46 %). ESD provided a higher complete resection rate (OR: 1.63 [I95 %: 1.06, 2.50] , P = 0.03, I2: 59 %), but there was no risk difference in the risk of local recurrence (RD: – 0.03 [CI95 %: – 0.07, 0.01], P = 0.15, I2: 0 %) or delayed bleeding. ESD was associated with an increased number of intraoperative perforations [RD: 0.12 (CI95 %: 0.04, 0.20), P = 0.002, I2: 56 %] and emergency surgery for delayed perforations. The inclusion of eligible studies was limited to retrospective series with inequalities in comparative groups. Conclusions Duodenal ESD for NASDTs may achieve higher en-bloc and complete resections at the expense of a greater perforation rate compared to EMR. The impact on local recurrence remains uncertain.
    Type of Medium: Online Resource
    ISSN: 2364-3722 , 2196-9736
    URL: Article
    DOI: 10.1055/a-0579-9050
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2018
    detail.hit.zdb_id: 2761052-4
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
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