Efficacy And Safety Analysis Of Endoscopic Submucosal Dissection In The Treatment Of Duodenal Lesions

Objective:Endoscopic Submucosal Dissection(ESD)has been widely used in the resection of duodenal lesion due to its smaller trauma and faster recovery.However,ESD is still controversial due to its difficult operation and high incidence of adverse events in the treatment of duodenal lesions.We retrospectively analyzed the clinical characteristics and pathological data of patients with duodenal lesions treated by ESD to explore the efficacy and safety of duodenal ESD.Methods:We conducted a retrospective observational study of 170 patients with duodenal lesion,who underwent ESD at the First Affiliated Hospital of Nanchang University in the period between January 2010 to May 2020.The clinical characteristics and endoscopic manifestations of 170 patients were collected such as gender,age,lesion site,lesion size,lesion origin level,pathological types of ESD specimens,and complications.Univariate and multivariate analysis methods were used to analyze the risk factors associated with ESD non-curative resection.Results : A total of 170 patients with duodenal lesion were included in ESD treatment.There were 75 males(44.1%)and 95 females(55.9%)with an average age of 52.2±11.4 years old and an average diameter of 11.9±10.2mm.130(76.5%)patients lesions located at the bulb,21(12.3%)at Junction of the first and second portions and 19(11.2%)at the descending portion.EUS had been completed in all patients before ESD treatment.Lesions were divided into mucosal layer in 17 cases(10.0%),submucosal layer in 118 cases(69.4%),and muscular layer in 35 cases(20.6%)according to the lesion origin level.According to pathological diagnosis,it is divided into: Ectopic pancreas(n=46,27.1%),neuroendocrine neoplasm(n=39,22.9%),adenoma(n=22,12.9%),Gastrointestinal stromal tumor(n=17,10%),lipoma(n=16,9.4%),brunner’s gland hyperplasia(n=15,8.8%),polyp(n=7,4.1%),ectopic gastric mucosa(n=3,1.8%),neurofibroma(n=2,1.2%),carcinoid(n=2,1.2%)and leiomyoma(n=1,0.6%).Among them,118 cases(69.4%)were resected en bloc,and 102 cases(60.0%)were R0 resected.There were 36 cases of intraoperative bleeding(21.2%),32 cases of intraoperative perforation(18.8%),1 case of delayed bleeding (0.6%),and 3 cases of delayed perforation(1.8%).Logistic regression analysis found that tumor diameter ≥20mm(OR=3.039,95%CI: 1.202-7.687)and pathological diagnosis of ectopic pancreas(OR=4.875,95%CI: 2.233-10.644)were independent risk factors for ESD non-R0 resection of duodenal lesion.Operation time(OR=1.033,95%CI: 1.016-1.051)was an independent risk factor for bleeding during ESD.Operative time(OR=1.031,95%CI: 1.003~1.071)and complete resection(OR=3.114,95%CI: 1.231~7.875)were independent risk factors for ESD perforation of duodenal lesion.Conclusions:(1)ESD treatment of duodenal lesions has a higher complete resection rate,less surgical trauma,and low incidence of adverse events.(2)ESD treatment should be more cautious for patients with lesion diameter>20mm and pathological diagnosis of ectopic pancreas,for the risk of non-R0 resection after ESD is significantly increase.(3)Prolonged operation time will increase the risk of adverse events,and the patient’s condition should be fully evaluated before surgery to reduce the incidence of adverse events.