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Endoscopic submucosal dissection for proximal duodenal subepithelial lesions: a retrospective cohort study

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Abstract

Background and aim

Endoscopic submucosal dissection (ESD) has been used to remove subepithelial lesions (SELs) in recent years; however, duodenal ESD is associated with high rates of immediate or delayed bleeding and perforation. Whether ESD can be recommended for the treatment of duodenal SELs remains controversial. Therefore, we evaluated the efficacy and safety of ESD for duodenal SELs.

Methods

We conducted a retrospective cohort study in 62 patients (62 lesions) who underwent ESD for duodenal SELs between January 2012 and December 2020. The therapeutic outcomes from ESD for duodenal SELs and procedure-related complications were analyzed.

Results

En bloc resection and complete resection rates associated with duodenal ESD were 90.3% and 100%, respectively; four patients had a positive microscopic margin on pathologic examination. The median procedure time was 45 min (range 20–106 min). During the procedure, two patients received emergency surgery for uncontrolled bleeding and perforation, respectively. After the procedure, delayed bleeding occurred in three patients (4.8%), which was successfully managed by clipping, and delayed perforation occurred in two patients (3.2%) and needed emergency surgery. Risk factors related to complications were analyzed. Lesion size was found to be significantly associated with the complications (P = 0.028). No recurrences were detected, and no distant metastasis was observed in any patient during a median follow-up period of 45.5 months (range, 6–103 months).

Conclusion

Duodenal ESD is relatively safe and feasible for duodenal SELs, especially for lesions no more than 2 cm in size.

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Acknowledgements

This study is partly supported by Shanghai “New-Star” Youth Doctor Program [Grant No. HWRS2020087 (WA)], Scientific Research Program of Shanghai Municipal Science and Technology Commission [Grant No. 18411966300 (WA)], and 234 Subject Climbing peak Program of Changhai Hospital award to WA.

Funding

Shanghai “New-Star” Youth Doctor Program, HWRS2020087, Wei An, Scientific Research Program of Shanghai Municipal Science and Technology Commission, 18411966300, Wei An, 234 Subject Climbing peak Program of Changhai Hospital, 2020, Wei An.

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Author notes

  1. Yan-rong Zhang, Chang Sun, and Chun-li Cheng have contributed equally to this work.

Authors and Affiliations

  1. Department of Gastroenterology, Changhai Hospital of Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China

    Yan-rong Zhang, Chang Sun, Jie Gao, Jie Chen, Luo-wei Wang, Ying Chen, Xiao-hua Man, Xin-Gang Shi & Wei An

  2. Information Centre, Linfen Central Hospital, Shanxi, China

    Chun-li Cheng

  3. Department of Pathology, Changhai Hospital of Second Military Medical University, Shanghai, China

    Jing Zhang

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  1. Yan-rong Zhang
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  2. Chang Sun
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Correspondence to Xin-Gang Shi or Wei An.

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Disclosures

Yan-rong Zhang, Chang Sun, Chun-li Cheng, Jie Gao, Jing Zhang, Jie Chen, Luo-wei Wang, Yin Chen, Xiao-hua Man, Xin-Gang Shi, and Wei An have no conflicts of interest or financial ties to disclose.

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Zhang, Yr., Sun, C., Cheng, Cl. et al. Endoscopic submucosal dissection for proximal duodenal subepithelial lesions: a retrospective cohort study. Surg Endosc 36, 6601–6608 (2022). https://doi.org/10.1007/s00464-022-09068-2

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