Salvage treatment for local recurrence after endoscopic resection for superficial nonampullary duodenal epithelial tumors

Yushi Kawakami; Takashi Kanesaka; Daiki Kitagawa; Shunsuke Yoshii; Yuya Asada; Tomoya Ueda; Takehiro Ninomiya; Atsuko Kizawa; Yuki Okubo; Yasuhiro Tani; Satoki Shichijo; Sachiko Yamamoto; Yoji Takeuchi; Koji Higashino; Noriya Uedo; Tomoki Michida; Masanori Kitamura; Keiichiro Honma; Ryu Ishihara

doi:10.1016/j.gie.2023.10.049

Salvage treatment for local recurrence after endoscopic resection for superficial nonampullary duodenal epithelial tumors

Gastrointest Endosc. 2023 Oct 27:S0016-5107(23)03026-2. doi: 10.1016/j.gie.2023.10.049. Online ahead of print.

Authors

Yushi Kawakami¹, Takashi Kanesaka², Daiki Kitagawa¹, Shunsuke Yoshii¹, Yuya Asada¹, Tomoya Ueda¹, Takehiro Ninomiya¹, Atsuko Kizawa¹, Yuki Okubo¹, Yasuhiro Tani¹, Satoki Shichijo¹, Sachiko Yamamoto¹, Yoji Takeuchi¹, Koji Higashino¹, Noriya Uedo¹, Tomoki Michida¹, Masanori Kitamura³, Keiichiro Honma³, Ryu Ishihara¹

Affiliations

¹ Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.
² Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan; Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan. Electronic address: takashikanesaka@gmail.com.
³ Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan.

PMID: 39491112
DOI: 10.1016/j.gie.2023.10.049

Abstract

Background and aims: Local recurrence is a significant concern in endoscopic resection of superficial nonampullary duodenal tumors (SNADTs). Our objective was to elucidate the clinical outcomes of salvage endoscopic treatment.

Methods: This retrospective study included consecutive patients who underwent endoscopic resection of SNADTs between January 2013 and December 2021. Four hundred thirty-three patients were observed, excluding those with familial adenomatous polyposis and those who did not undergo surveillance endoscopy. Local recurrence was defined as histologically proven adenoma or adenocarcinoma in contact with a prior endoscopic resection scar. The clinicopathological characteristics of patients with local recurrence and outcomes of salvage endoscopic treatment were evaluated.

Results: Local recurrence occurred in 33 (8%) of the 433 patients after endoscopic resection for SNADT. Multivariate analysis identified older age (≥63 years), larger lesion size (≥13 mm), and piecemeal resection as significant independent predictors of local recurrence. Among the 33 patients with 33 recurrent lesions, 10 lesions (30%) disappeared after forceps biopsy. Three patients (9%) remained untreated. Sixteen lesions (48%) disappeared after one session of salvage endoscopic treatment, and four lesions (12%) disappeared after two sessions of treatment. Among these 24 treatment sessions, underwater endoscopic mucosal resection was performed in 19 sessions. The median post-procedural hospitalization period was four days (interquartile range, 3-4.25 days). Delayed bleeding occurred in three sessions. No recurrences have been detected in the 30 salvaged patients. The median recurrence-free survival time was 24.5 months (interquartile range, 14-48.75 months).

Conclusions: Local recurrence after endoscopic resection of SNADT can be managed endoscopically.

Keywords: adenocarcinoma; duodenal neoplasm; endoscopic mucosal resection; residual neoplasm; salvage treatment.