Underwater Endoscopic Mucosal Resection Vs Conventional Endoscopic Mucosal Resection for Superficial Nonampullary Duodenal Epithelial Tumors in the Western Setting

Rui Morais; José Amorim; Renato Medas; Bernardo Sousa-Pinto; João Santos-Antunes; Romain Legros; Jérémie Albouys; Frédéric Moll; Margarida Marques; Filipe Vilas-Boas; Eduardo Rodrigues-Pinto; Irene Gullo; Fátima Carneiro; Elisa Gravito Soares; Pedro Amaro; Pedro Mesquita; Jaime Rodrigues; Gianluca Andrisani; Sandro Sferrazza; Sara Archer; Ricardo Kuttner-Magalhães; Francisco Manzano; Enrique Rodríguez de Santiago; Alessandro Rimondi; Alberto Murino; Edward Despott; Mathieu Pioche; Jérémie Jacques; Guilherme Macedo

doi:10.1016/j.cgh.2024.05.011

Underwater Endoscopic Mucosal Resection Vs Conventional Endoscopic Mucosal Resection for Superficial Nonampullary Duodenal Epithelial Tumors in the Western Setting

Clin Gastroenterol Hepatol. 2024 May 22:S1542-3565(24)00485-3. doi: 10.1016/j.cgh.2024.05.011. Online ahead of print.

Authors

Rui Morais¹, José Amorim², Renato Medas³, Bernardo Sousa-Pinto⁴, João Santos-Antunes⁵, Romain Legros⁶, Jérémie Albouys⁶, Frédéric Moll⁷, Margarida Marques³, Filipe Vilas-Boas³, Eduardo Rodrigues-Pinto³, Irene Gullo⁸, Fátima Carneiro⁸, Elisa Gravito Soares⁹, Pedro Amaro⁹, Pedro Mesquita¹⁰, Jaime Rodrigues¹⁰, Gianluca Andrisani¹¹, Sandro Sferrazza¹², Sara Archer¹³, Ricardo Kuttner-Magalhães¹³, Francisco Manzano¹⁴, Enrique Rodríguez de Santiago¹⁴, Alessandro Rimondi¹⁵, Alberto Murino¹⁵, Edward Despott¹⁵, Mathieu Pioche⁷, Jérémie Jacques⁶, Guilherme Macedo³

Affiliations

¹ Gastroenterology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal. Electronic address: u011791@chsj.min-saude.pt.
² Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal.
³ Gastroenterology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal.
⁴ Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde/Rede de Investigação em Saúde, Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal.
⁵ Gastroenterology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal; Instituto de Patologia e Imunologia Molecular da Universidade do Porto/Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.
⁶ Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France.
⁷ Department of Hepatology and Gastroenterology, Edouard Herriot Hospital, Lyon, France.
⁸ Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal; Instituto de Patologia e Imunologia Molecular da Universidade do Porto/Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal; Department of Pathology, Centro Hospitalar Universitário São João, Porto, Portugal.
⁹ Gastroenterology Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal.
¹⁰ Gastroenterology Department, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal.
¹¹ Digestive Endoscopy Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
¹² Digestive Endoscopy Unit, Arnas Ospedale Civico Palermo, Palermo, Italy.
¹³ Gastroenterology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal.
¹⁴ Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Universidad de Alcalá, Madrid, Spain.
¹⁵ Royal Free Unit for Endoscopy, Royal Free London National Health Service Foundation Trust, London, United Kingdom; University College London Institute for Liver and Digestive Health, London, United Kingdom.

PMID: 38782173
DOI: 10.1016/j.cgh.2024.05.011

Abstract

Background & aims: Conventional endoscopic mucosal resection (C-EMR) is established as the primary treatment modality for superficial nonampullary duodenal epithelial tumors (SNADETs), but recently underwater endoscopic mucosal resection (U-EMR) has emerged as a potential alternative. The majority of previous studies focused on Asian populations and small lesions (≤20 mm). We aimed to compare the efficacy and outcomes of U-EMR vs C-EMR for SNADETs in a Western setting.

Methods: This was a retrospective multinational study from 10 European centers that performed both C-EMR and U-EMR between January 2013 and July 2023. The main outcomes were the technical success, procedure-related adverse events (AEs), and the residual/recurrent adenoma (RRA) rate, evaluated on a per-lesion basis. We assessed the association between the type of endoscopic mucosal resection and the occurrence of AEs or RRAs using mixed-effects logistic regression models (propensity scores). Sensitivity analyses were performed for lesions ≤20 mm or >20 mm.

Results: A total of 290 SNADETs submitted to endoscopic resection during the study period met the inclusion criteria and were analyzed (C-EMR: n = 201, 69.3%; U-EMR: n = 89, 30.7%). The overall technical success rate was 95.5% and comparable between groups. In logistic regression models, compared with U-EMR, C-EMR was associated with a significantly higher frequency of overall delayed AEs (odds ratio [OR], 4.95; 95% CI, 2.87-8.53), postprocedural bleeding (OR, 7.92; 95% CI, 3.95-15.89), and RRAs (OR, 3.66; 95% CI, 2.49-5.37). Sensitivity analyses confirmed these results when solely considering either small (≤20 mm) or large (>20 mm) lesions.

Conclusions: Compared with C-EMR, U-EMR was associated with a lower rate of overall AEs and RRAs, regardless of lesion size. Our results confirm the possible role of U-EMR as an effective and safe technique in the management of SNADETs.

Keywords: Conventional Endoscopic Mucosal Resection; Endoscopic Resection; Superficial Nonampullary Duodenal Epithelial Tumors; Underwater Endoscopic Mucosal Resection.