Free-Hand Endoscopic Full-Thickness Resection for Duodenal Subepithelial Lesions

IF 3.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Journal of Gastroenterology and Hepatology Pub Date : 2025-01-22 DOI:10.1111/jgh.16878

Peirong Xu, Zuqiang Liu, Li Wang, Yifan Qu, Chenchao Xu, Anyi Xiang, Wei Su, Tao Tan, Jiyuan Zhang, Lu Yao, Meidong Xu, Yunshi Zhong, Quanlin Li, Pinghong Zhou, Hao Hu

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Abstract

Background and Aim

This work aims to evaluate the efficacy and safety of free-hand endoscopic full-thickness resection (EFTR) for duodenal subepithelial lesions (SELs).

Methods

We performed a retrospective review of 105 patients with duodenal SELs who underwent free-hand EFTR. Free-hand EFTR means no other devices (over-the-scope clip or full-thickness resection device) are required. The preoperative baseline data, procedure-related characteristics, and postoperative outcomes were analyzed.

Results

The technical success rate was 99.0%, and the en bloc resection rate was 94.2%. A total of nine (8.7%) patients experienced major postoperative adverse events (AEs). The incidence of major AEs was significantly higher for lesions with a maximum diameter ≥ 2 cm (30.4%) than for lesions with a maximum diameter < 2 cm (2.6%) (p < 0.001). There were also significant differences in the incidence of major AEs for peri-ampullary lesions (37.5%), bulb lesions (4.8%), bulb-descending junction lesions (6.7%), and descending part lesions (12.5%) (p = 0.032). Multivariable regression analyses revealed that the maximum diameter ≥ 2 cm (OR = 18.108; 95% CI = 1.881–174.281; p = 0.012) and lesions located in peri-ampullary (OR = 18.950; 95% CI = 1.219–294.648; p = 0.036) were independent risk factors for major AEs. The mean duration of the follow-up period was 36.6 ± 21.3 months, and only one patient with gastrointestinal stromal tumors recurred.

Conclusions

Free-hand EFTR is a safe and effective technique for nonampullary duodenal SELs with a maximum diameter of < 2 cm. Given the complexity of the duodenal anatomy, this procedure should be performed by experienced endoscopists.

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徒手内镜下十二指肠上皮下病变全层切除术。

背景与目的：本研究旨在评价徒手内镜下全层切除术（EFTR）治疗十二指肠上皮下病变（SELs）的有效性和安全性。方法：我们对105例接受徒手EFTR的十二指肠SELs患者进行了回顾性分析。徒手EFTR意味着不需要其他装置（超镜夹或全层切除装置）。分析术前基线数据、手术相关特征和术后结果。结果：技术成功率为99.0%，整体切除率为94.2%。共有9例（8.7%）患者出现重大术后不良事件（ae）。结论：徒手EFTR是一种安全有效的治疗非壶腹性十二指肠SELs的技术，最大直径≥2 cm的主要ae发生率（30.4%）明显高于最大直径为

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来源期刊

Journal of Gastroenterology and Hepatology 医学-胃肠肝病学

CiteScore

7.90

自引率

2.40%

发文量

326

审稿时长

2.3 months

期刊介绍： Journal of Gastroenterology and Hepatology is produced 12 times per year and publishes peer-reviewed original papers, reviews and editorials concerned with clinical practice and research in the fields of hepatology, gastroenterology and endoscopy. Papers cover the medical, radiological, pathological, biochemical, physiological and historical aspects of the subject areas. All submitted papers are reviewed by at least two referees expert in the field of the submitted paper.