背景:水下内镜下黏膜切除术(UEMR)和冷圈套器息肉切除术(CSP)是治疗浅表性非壶腹十二指肠上皮肿瘤(SNADET)的新型内镜手术。然而,关于如何适当使用这两个程序的共识尚未建立。在这项研究中,我们评估了两种手术的治疗结果,包括可切除性。
方法:在2020年1月至2022年6月进行的这项单中心随机对照研究中,SNADETs≤12mm的患者被随机分为UEMR组和CSP组。主要终点是足够的垂直R0切除(SVR0),定义为包括足够的粘膜下层的R0切除。我们比较了两组之间的治疗结果,包括SVR0率。
结果:UEMR组的SVR0率明显高于CSP组(65.6%vs.41.5%,P=0.01)。相比之下,研究组之间的R0切除率无显著差异(70.3%vs.61.5%,P=0.29)。UEMR组的粘膜下层厚度明显大于CSP组(中位数546[范围,309-833]µmvs.69[0-295]µm,P<0.01)。CSP的总手术时间较短(中位数12[范围,8-16]minvs.1[1-3]分钟,P<0.01)和更少的总出血事件(9.4%vs.1.5%,P=0.06)。
结论:UEMR与CSP相比具有更好的垂直可切除性,但CSP的手术时间较短,出血事件较少.虽然CSP对于大多数小型SNADET来说是优选的,对于不能明确诊断为粘膜低度肿瘤的病变,应选择UEMR。
Underwater endoscopic mucosal resection (UEMR) and cold snare polypectomy (CSP) are novel endoscopic procedures for superficial nonampullary duodenal epithelial tumors (SNADET). However, consensus on how to use both procedures appropriately has not been established. In this study, we evaluated treatment outcomes of both procedures, including resectability.
In this single-center randomized controlled study conducted between January 2020 and June 2022, patients with SNADET ≤12 mm were randomly allocated to UEMR and CSP groups. The primary end point was sufficient vertical R0 resection (SVR0), which was defined as R0 resection including a sufficient submucosal layer. We compared treatment outcomes including SVR0 rate between groups.
The SVR0 rate was significantly higher in the UEMR group than in the CSP group (65.6% vs 41.5%, P = 0.01). By contrast, the R0 resection rate was not significantly different between study groups (70.3% vs 61.5%, P = 0.29). The submucosal layer thickness was significantly greater in the UEMR group than in the CSP group (median 546 [range, 309-833] μm vs 69 [0-295] μm, P < 0.01). CSP had a shorter total procedure time (median 12 [range, 8-16] min vs 1 [1-3] min, P < 0.01) and fewer total bleeding events (9.4% vs 1.5%, P = 0.06).
UEMR has superior vertical resectability compared with CSP, but CSP has a shorter procedure time and fewer bleeding events. Although CSP is preferable for most small SNADET, UEMR should be selected for lesions that cannot be definitively diagnosed as mucosal low-grade neoplasias.