Clinical course and management of adverse events after endoscopic resection of superficial duodenal epithelial tumors: Multicenter retrospective study

Osamu Dohi; Motohiko Kato; Yoji Takeuchi; Shu Hoteya; Tsuneo Oyama; Satoru Nonaka; Shoichi Yoshimizu; Masao Yoshida; Ken Ohata; Yoshimasa Miura; Yuko Hara; Shigetsugu Tsuji; Yasushi Yamasaki; Hiroya Ueyama; Koichi Kurahara; Tomoaki Tashima; Nobutsugu Abe; Atsushi Nakayama; Ichiro Oda; Naohisa Yahagi

doi:10.1111/den.14552

Clinical course and management of adverse events after endoscopic resection of superficial duodenal epithelial tumors: Multicenter retrospective study

Dig Endosc. 2023 Nov;35(7):879-888. doi: 10.1111/den.14552. Epub 2023 Apr 23.

Authors

Osamu Dohi¹, Motohiko Kato², Yoji Takeuchi³, Shu Hoteya⁴, Tsuneo Oyama⁵, Satoru Nonaka⁶, Shoichi Yoshimizu⁷, Masao Yoshida⁸, Ken Ohata⁹, Yoshimasa Miura¹⁰, Yuko Hara¹¹, Shigetsugu Tsuji¹², Yasushi Yamasaki¹³, Hiroya Ueyama¹⁴, Koichi Kurahara¹⁵, Tomoaki Tashima¹⁶, Nobutsugu Abe¹⁷, Atsushi Nakayama², Ichiro Oda⁶, Naohisa Yahagi²

Affiliations

¹ Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
² Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan.
³ Department of Gastrointestinal Oncology and Division of Hereditary Tumors, Department of Genetic Oncology, Osaka International Cancer Institute, Osaka, Japan.
⁴ Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
⁵ Department of Endoscopy, Saku Central Hospital Advanced Care Center, Nagano, Japan.
⁶ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
⁷ Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan.
⁸ Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan.
⁹ Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan.
¹⁰ Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan.
¹¹ Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan.
¹² Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan.
¹³ Department of Gastroenterology, Okayama University Hospital, Okayama, Japan.
¹⁴ Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan.
¹⁵ Division of Gastroenterology, Matsuyama Red Cross Hospital, Ehime, Japan.
¹⁶ Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan.
¹⁷ Department of Gastroenterological and General Surgery, Kyorin University Faculty of Medicine, Tokyo, Japan.

PMID: 36945191
DOI: 10.1111/den.14552

Abstract

Objectives: This study aimed to elucidate the clinical course and management of adverse events (AEs) after endoscopic resection (ER) for superficial duodenal epithelial tumors (SDETs).

Methods: Consecutive patients who underwent ER of SDETs between January 2008 and July 2018 at 18 Japanese institutions were retrospectively enrolled. The study outcomes included the clinical course, management, and risk of surgical conversion with perioperative AEs after ER for SDETs.

Results: Of the 226 patients with AEs, the surgical conversion rate was 8.0% (18/226), including 3.7% (4/108), 1.0% (1/99), and 50.0% (12/24) of patients with intraoperative perforation, delayed bleeding, or delayed perforation, respectively. In the multivariate logistic analysis, involvement of the major papilla (odds ratio [OR] 12.788; 95% confidence interval [CI] 2.098-77.961, P = 0.006) and delayed perforation (OR 37.054; 95% CI 10.219-134.366, P < 0.001) were significant risk factors for surgical conversion after AEs. Delayed bleeding occurred from postoperative days 1-14 or more, whereas delayed perforation occurred within 3 days in all cases.

Conclusions: The surgical conversion rate was higher for delayed perforation than those for other AEs after ER of SDETs. Involvement of the major papilla and delayed perforation were significant risk factors for surgical conversion following AEs. In addition, reliable prevention of delayed perforation is required for 3 days after duodenal ER to prevent the need for surgical interventions.

Keywords: adverse event; delayed perforation; endoscopic resection; superficial duodenal epithelial tumor; surgical conversion.

Publication types

Multicenter Study

MeSH terms

Ampulla of Vater* / pathology
Carcinoma*
Disease Progression
Duodenal Neoplasms* / pathology
Duodenal Neoplasms* / surgery
Endoscopic Mucosal Resection* / adverse effects
Humans
Retrospective Studies
Treatment Outcome