Novel Traction-Assisted Endoscopic Resection for Superficial Non-ampullary Duodenal Epithelial Tumors: 15-Year Experience from a Large Tertiary Center.

OBJECTIVE

Endoscopic resection has become an accepted approach for the treatment of superficial non-ampullary duodenal epithelial tumors (SNADETs), but there are technical challenges, especially during ESD for SNADETs. The aim of this study is to evaluate the efficacy and safety of an innovative traction technique for ESD in the treatment of SNADETs.

METHODS

We sought to evaluate the clinical value of detachable clip combined with rubber band-assisted ESD (DCRB-ESD) in the treatment of SNADETs in a large tertiary center. The patients who underwent DCRB-ESD or conventional endoscopic submucosal dissection (C-ESD) between July 2010 and December 2025 were enrolled in this study. Propensity score matching was applied to match patients with similar baseline characteristics. The clinical characteristics of patients and lesions, submucosal fibrosis, procedural time, therapeutic outcomes, adverse events, and follow-up data were analyzed.

RESULTS

One hundred and forty-nine patients were included in this study. Of these patients, 54 patients were matched in each group via propensity score matching. The en bloc resection rate and R0 resection rate of SNADETs in the DCRB-ESD group were superior to those in the C-ESD group [100 vs. 94.4%, P = 0.24; 96.3 vs. 85.2%, P < 0.05]. The procedure time was significantly shorter in the DCRB-ESD group than in the C-ESD group [48.5(28.9-81.2) vs. 57.1(40.1-119.8) min, P < 0.05]. Although there were no statistical differences in postoperative complications (1.9 vs. 5.6%, P = 0.62), the rate of intraoperative complications in the DCRB-ESD group was significantly lower than that in the C-ESD group (7.4 vs. 22.2%, P < 0.05).

CONCLUSION

DCRB-ESD is a safe and effective method for treating superficial duodenal epithelial tumors. It can shorten procedural time, reduce technical difficulty, and may facilitate the management of larger lesions or those with submucosal fibrosis.