Safety and efficacy of surgical and endoscopic resection in the treatment of duodenal subepithelial lesions

Surg Endosc. 2022 Jun;36(6):4145-4153. doi: 10.1007/s00464-021-08740-3. Epub 2021 Sep 22.


Background: Duodenal subepithelial lesions (D-SELs) are rare and their resection is challenging. Unfortunately, data on surgical and endoscopic resection of D-SELs are scarce. This study aimed to assess the safety and efficacy of surgical resection and endoscopic resection (ER) for D-SELs.

Methods: We retrospectively analyzed clinical data of patients with non-ampullary D-SELs who underwent ER or surgery and compared the outcomes between ER and surgery with no/low-risk SELs over 15 mm from March 2010 to August 2020. Clinicopathologic findings, procedure-related parameters, and follow-up data were analyzed.

Results: A total of 107 patients (108 lesions) were enrolled; 52 patients (53 lesions) received ER and 55 patients (55 lesions) received surgery. In ER group, en bloc resection rate and R0 resection rate were 94 and 89%, respectively. Major adverse events rate was 6%. One (2%) patient experienced local recurrence. In surgery group, R0 resection was achieved in all cases. Major adverse events rate was 20%. Recurrence rate and distant metastases rate were 4 and 8%, respectively. One (2%) patient died from septicemia during follow-up. Thirty-three patients in each group were enrolled in the comparison. There were no significant differences in age, sex, lesion size and location (P > 0.05). More histologically GISTs and muscularis propria-originated lesions were treated by surgery (P < 0.05). ER was significantly associated with a shorter operation time, shorter hospital stay, lower cost, less estimated blood loss, and lower major adverse events rate compared to the surgery group (P < 0.05). However, R0 resection rate, mortality, recurrence rate, and metastases rate were not significant different (P > 0.05).

Conclusions: ER is an effective and safe treatment modality for selected patients with non-ampullary D-SELs by expert endoscopists. Surgery is a radical method for D-SELs that should be reserved for D-SELs not amenable to ER.

Keywords: Duodenum; Endoscopic resection; Subepithelial tumors; Surgery; Treatment.

MeSH terms

  • Duodenal Neoplasms* / pathology
  • Duodenal Neoplasms* / surgery
  • Duodenum / surgery
  • Endoscopic Mucosal Resection* / methods
  • Gastrointestinal Stromal Tumors* / pathology
  • Gastrointestinal Stromal Tumors* / surgery
  • Humans
  • Retrospective Studies
  • Treatment Outcome