Nonrecurrence Rate of Underwater EMR for ≤20-mm Nonampullary Duodenal Adenomas: A Multicenter Prospective Study (D-UEMR Study).

Adenoma / pathology Duodenal Neoplasms / pathology Endoscopic Mucosal Resection / adverse effects Humans Intestinal Mucosa / pathology Prospective Studies Retrospective Studies Treatment Outcome

Duodenal Adenoma Follow-Up Nonrecurrence Rate Underwater Endoscopic Mucosal Resection

Journal

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association

ISSN: 1542-7714

Titre abrégé: Clin Gastroenterol Hepatol

Pays: United States

ID NLM: 101160775

Informations de publication

Date de publication:
05 2022

Historique:

received: 24 06 2021

accepted: 25 06 2021

pubmed: 5 7 2021

medline: 20 4 2022

entrez: 4 7 2021

Statut: ppublish

Résumé

Endoscopic resection of nonampullary duodenal adenoma is often challenging, and its technique has not yet been standardized. To overcome the practical difficulty of conventional endoscopic mucosal resection, underwater endoscopic mucosal resection (UEMR) was recently developed; therefore, we investigated the effectiveness and safety of UEMR for nonampullary duodenal adenoma. A multicenter, prospective cohort study was conducted at 21 institutions in Japan. We enrolled patients with no more than 2 nonampullary duodenal adenomas ≤20 mm in size, who were planned to undergo UEMR. After UEMR, follow-up endoscopies were scheduled at 2 and 12 months after the procedure, and biopsy specimens were taken from the post-UEMR scars. The primary endpoint was the proportion of patients with histologically proven nonrecurrence at follow-up endoscopy and biopsy. A total of 155 patients with 166 lesions underwent UEMR. One patient with a non-neoplastic lesion in the resected specimen and 10 patients with 10 lesions who were lost to follow-up were excluded. Finally, 144 patients with 155 lesions who received all follow-up endoscopies were analyzed for the primary endpoint. The proportion of patients with proven nonrecurrence was 97.2% (n = 140 of 144; 95% confidence interval, 92.8%-99.1%) which exceeded the predefined threshold value (92%). Two cases of delayed bleeding (1.2%) occurred and they were successfully managed by clips. All recurrences were successfully treated by additional endoscopic treatment. This multicenter, prospective cohort study demonstrated effectiveness and safety of UEMR for nonampullary duodenal adenomas ≤20 mm in size. (University Hospital Medical Network Clinical Trials Registry, Number: UMIN000030414).

Sections du résumé

BACKGROUND AND AIMS

METHODS

A multicenter, prospective cohort study was conducted at 21 institutions in Japan. We enrolled patients with no more than 2 nonampullary duodenal adenomas ≤20 mm in size, who were planned to undergo UEMR. After UEMR, follow-up endoscopies were scheduled at 2 and 12 months after the procedure, and biopsy specimens were taken from the post-UEMR scars. The primary endpoint was the proportion of patients with histologically proven nonrecurrence at follow-up endoscopy and biopsy.

RESULTS

A total of 155 patients with 166 lesions underwent UEMR. One patient with a non-neoplastic lesion in the resected specimen and 10 patients with 10 lesions who were lost to follow-up were excluded. Finally, 144 patients with 155 lesions who received all follow-up endoscopies were analyzed for the primary endpoint. The proportion of patients with proven nonrecurrence was 97.2% (n = 140 of 144; 95% confidence interval, 92.8%-99.1%) which exceeded the predefined threshold value (92%). Two cases of delayed bleeding (1.2%) occurred and they were successfully managed by clips. All recurrences were successfully treated by additional endoscopic treatment.

CONCLUSIONS

This multicenter, prospective cohort study demonstrated effectiveness and safety of UEMR for nonampullary duodenal adenomas ≤20 mm in size. (University Hospital Medical Network Clinical Trials Registry, Number: UMIN000030414).

Identifiants

DOI: 10.1016/j.cgh.2021.06.043 PMID: 34217879

pubmed: 34217879

pii: S1542-3565(21)00707-2

doi: 10.1016/j.cgh.2021.06.043

pii:

doi:

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

Pagination

1010-1018.e3

Investigateurs

Hiromitsu Kanzaki (H)

Shuntaro Inoue (S)

Muneaki Miyake (M)

Masayasu Ohmori (M)

Yoji Takeuchi (Y)

Yasuhiro Tani (Y)

Nobuyuki Harada (N)

Nobukazu Agatsuma (N)

Keijirou Okada (K)

Maiko Ikenouchi (M)

Yasuki Nakatani (Y)

Yoshito Uenoyama (Y)

Yukitaka Yamashita (Y)

Shigenao Ishikawa (S)

Tomoki Inaba (T)

Koji Miyahara (K)

Yuki Moritou (Y)

Masahiro Nakagawa (M)

Hiroaki Kitae (H)

Tsugitaka Ishida (T)

Yuji Naito (Y)

Akiyoshi Nishio (A)

Masaaki Shimatani (M)

Ryo Kato (R)

Shinya Taki (S)

Koichiro Mandai (K)

Kasumi Sanada (K)

Kojiro Nakase (K)

Hiroko Nebiki (H)

Shunsuke Saito (S)

Toshiyuki Wakatsuki (T)

Naoyuki Nishimura (N)

Commentaires et corrections

Type : CommentIn