Comparison of the Clinical Outcomes Between Gel Immersion and Underwater Endoscopic Mucosal Resection for Superficial Non‐ampullary Duodenal Epithelial Tumors (With Video)
Mitsuru Otsuka, Takuto Hikichi, Jun Nakamura, Tsunetaka Kato, Minami Hashimoto, Takumi Yanagita, Eisuke Kameoka, Rei Suzuki, Mitsuru Sugimoto, Hiroyuki Asama, Hiroshi Shimizu, Kento Osawa, Rei Ohira, Daiki Nemoto, Yuko Hashimoto, Masao Kobayakawa, Hiromasa OhiraABSTRACT
Objective
Gel immersion endoscopic mucosal resection (GIEMR) has recently emerged as a novel technique for superficial non‐ampullary duodenal epithelial tumors (SNADETs). However, its clinical advantages over underwater EMR (UEMR) remain unclear. This study compared the short‐ and long‐term outcomes of GIEMR and UEMR for SNADETs.
Methods
We retrospectively analyzed patients with SNADETs who underwent UEMR or GIEMR. The R0 resection rate, procedural duration, adverse events, and local recurrence were compared between the groups. Risk factors for non‐R0 resection were evaluated using logistic regression analyses.
Results
Thirty‐two and 49 patients in the UEMR and GIEMR groups, respectively, were included. The R0 resection rate was higher in the GIEMR group than in the UEMR group (GIEMR vs. UEMR; 47.4 vs. 25.7%, p = 0.039). The procedural duration from liquid injection to completion of resection was shorter in the GIEMR group (4 vs. 6 min, p = 0.038). No delayed bleeding or perforation occurred in either group. Kaplan–Meier analysis demonstrated no significant difference in the cumulative local recurrence rate at 3 years between the groups (log‐rank test, p = 0.902). Tumor size and UEMR were identified as risk factors for non‐R0 resection in the univariate analysis; however, in the multivariate analysis, tumor size was identified as the only independent risk factor for non‐R0 resection (odds ratio, 1.172; 95% confidence interval, 1.050–1.309; p = 0.005).
Conclusions
GIEMR achieved a higher R0 resection rate and shorter procedural duration than UEMR without increasing adverse events; longer follow‐up is warranted.
Trial Registration
N/A (Only approval of the research protocol by an Institutional Reviewer Board of Fukushima Medical University).