Comparison of the Clinical Outcomes Between Gel Immersion and Underwater Endoscopic Mucosal Resection for Superficial Non-ampullary Duodenal Epithelial Tumors (With Video).
GIEMR showed a higher R0 resection rate and shorter procedure time than UEMR for SNADETs, but further long-term studies are needed.
Where it sits
this study against the rest of the hcg (human chorionic gonadotropin) corpusSummary and findings
This study compared gel immersion endoscopic mucosal resection (GIEMR) and underwater endoscopic mucosal resection (UEMR) for superficial non-ampullary duodenal epithelial tumors (SNADETs). The R0 resection rate and procedural duration were measured among 81 patients. GIEMR demonstrated a higher R0 resection rate and shorter procedural duration compared to UEMR.
Abstract
<h4>Objective</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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%, <i>p</i> = 0.039). The procedural duration from liquid injection to completion of resection was shorter in the GIEMR group (4 vs. 6 min, <i>p</i> = 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, <i>p</i> = 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; <i>p</i> = 0.005).<h4>Conclusions</h4>GIEMR achieved a higher R0 resection rate and shorter procedural duration than UEMR without increasing adverse events; longer follow-up is warranted.<h4>Trial registration</h4>N/A (Only approval of the research protocol by an Institutional Reviewer Board of Fukushima Medical University).
Background
This paper addresses the clinical outcomes of two techniques for resecting superficial non-ampullary duodenal epithelial tumors (SNADETs). Previous studies have indicated varying effectiveness of endoscopic mucosal resection techniques, but direct comparisons between gel immersion and underwater methods have been limited. Understanding the differences in outcomes could inform clinical practice and improve patient management.
Methods
A retrospective analysis was conducted on patients with SNADETs who underwent either GIEMR or UEMR. The study compared R0 resection rates, procedural duration, adverse events, and local recurrence rates. The sample consisted of 32 patients in the UEMR group and 49 in the GIEMR group.
Results
The R0 resection rate was significantly higher in the GIEMR group at 47.4% compared to 25.7% in the UEMR group (p=0.039). The procedural duration was shorter in the GIEMR group, averaging 4 minutes compared to 6 minutes for UEMR (p=0.038). No adverse events such as delayed bleeding or perforation were reported in either group. The cumulative local recurrence rate at 3 years showed no significant difference between the groups (p=0.902). Tumor size was identified as a significant risk factor for non-R0 resection (odds ratio 1.172, 95% CI 1.050-1.309, p=0.005).
Interpretation
The findings suggest that GIEMR may offer advantages over UEMR in terms of R0 resection rates and procedural efficiency. However, while the statistical significance of these results is noted, the clinical significance may vary based on individual patient factors. The retrospective nature of the study and the lack of long-term follow-up limit the ability to draw definitive conclusions about the long-term efficacy and safety of these techniques.
Key findings
- R0 resection rate: 47.4% in GIEMR vs 25.7% in UEMR, p=0.039.
- Procedural duration: 4 min in GIEMR vs 6 min in UEMR, p=0.038.
- No delayed bleeding or perforation occurred in either group.
- Cumulative local recurrence rate at 3 years: p=0.902.
- Odds ratio for tumor size as a risk factor for non-R0 resection: 1.172, 95% CI 1.050-1.309, p=0.005.
Limitations
- Retrospective study design.
- Small sample size (n=81).
- Lack of long-term follow-up data.
- No information on potential confounding factors.