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UNDERWATER EMR VERSUS CONVENTIONAL EMR FOR NONAMPULLARY DUODENAL ADENOMAS

Renato Medas 1, Rui Morais 1, José Amorim 2, João Santos-Antunes 1, Margarida Marques 1, Filipe Vilas-Boas 1, Guilherme Macedo 1

Affiliations

1 Centro Hospitalar e Universitário de São João, Porto, Portugal

2 Faculty of Medicine of University of Porto, Porto, Portugal

Summary

AI Generated

Retrospective case-control study comparing underwater EMR versus conventional EMR for superficial nonampullary duodenal epithelial tumours found similar efficacy and safety between the two techniques.

In 40 duodenal adenomas (31 patients), residual/recurrent adenoma rate was numerically lower with underwater EMR compared to conventional EMR (10% vs. 30%, p=0.22), though not statistically significant.
Technical success and en bloc resection rates were similar between underwater EMR and conventional EMR (100% vs. 90.9% and 44.4% vs. 54.2%, respectively).
Post-EMR defects were more commonly closed in the underwater EMR group (83.3% vs. 45.5%, p<0.05).
Peri-procedural bleeding rates were similar (11.1% underwater EMR vs. 13.6% conventional EMR), with no delayed complications in the underwater EMR group versus two delayed bleeding cases with conventional EMR.
This Western tertiary center experience suggests underwater EMR is a feasible option for managing superficial nonampullary duodenal epithelial tumours, an area where the technique has not been comprehensively assessed.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Underwater endoscopic mucosal resection (U-EMR) is an emerging technique in the management of superficial nonampullary duodenal epithelial tumours (SNADETs). Nevertheless, particularly in Western centers, its application has not been comprehensively assessed.

Aims & Methods

Our aim was to compare the efficacy and safety of U-EMR versus conventional EMR (C-EMR) for the endoscopic treatment of SNADETs.
Retrospective case-control study that analyzed all patients who underwent duodenal EMR in a tertiary reference center, between 2015 and 2022. SNADETs ≥10 mm removed by U-EMR or C-EMR were included. Primary endpoint was residual/recurrent adenoma rate (RAR). Secondary outcomes were rates of technical success, en bloc resection, and adverse events (AE).

Results

A total of 40 duodenal adenomas (31 patients) were included (U-EMR n=18; C-EMR n=22). Median lesion size was 16.5 ± 13.3 mm. Lesions were predominantly IIa (47.5%) and IIa+c (20%) - Paris classification. Most lesions were in the second portion of duodenum (n=35).
Groups were similar regarding age, gender and lesion size. There were no significantly statistically differences between groups regarding technical success (100% U-EMR vs. 90.9% C-EMR, p=0.19) and en bloc resection rate (44.4% U-EMR vs. 54.2% C-EMR, p=0.53). RAR was higher in the C-EMR group (n=6/20, 30% vs. n=1/10, 10%, p=0.22), although without statistically significance. Post-EMR defects were more commonly closed in U-EMR group (83.3% vs. 45.5%, p <0.05). Peri-procedural AE rate (bleeding n=2 [11.1%] U-EMR vs. bleeding n=3 [13.6%] C-EMR, p=0.81) was similar between groups. There were no delayed complications in the U-EMR group while in the C-EMR group there were 2 cases of bleeding (0% vs. 9.1%, p= 0.19).

Conclusion

In our study, compared to C-EMR, U-EMR showed similar RAR and safety, highlighting its role as a feasible therapeutic option for the management of SNADETs.

Conference

UEG Week Copenhagen 2023

Topics

Oesophagus

Submission format

Abstract

Session

PP 01 Oesophageal, gastric and duodenal disorders (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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