Clinical outcomes of endoscopic submucosal dissection for previously treated superficial non-ampullary duodenal epithelial tumors.

BACKGROUND AND AIMS: Endoscopic submucosal dissection (ESD) is increasingly used for superficial non-ampullary duodenal epithelial tumors (SNADETs). However, evidence from the United States (US) is limited. Moreover, the effectiveness and safety of ESD for previously treated SNADETs remain unclear. This study aimed to evaluate the outcomes of ESD for previously treated SNADETs.

METHODS

This single-center retrospective cohort study included patients undergoing ESD for SNADETs at a US tertiary center between October 2018 and February 2025. Short-term outcomes (en bloc/R0 resection and adverse events) were compared between treatment-naïve and previously treated groups. Long-term outcomes were assessed by the presence of residual lesions after a single procedure.

RESULTS

A total of 45 ESDs in 37 patients were analyzed (29 treatment-naïve and 16 previously treated). En bloc (65.5% vs. 50.0%, p = 0.354) and R0 resection rates (48.3% vs. 37.5%, p = 0.544) did not differ between the groups, with comparable adverse events. Residual lesions after a single ESD tended to be more frequent in the previously treated group (6.9% vs. 31.3%, p = 0.079). Sensitivity analysis including all 47 endoscopic resections (ERs) supported this finding (6.9% vs. 33.3%, p = 0.041). In the primary analysis, all residual lesions were treated with repeat ER, and all patients achieved complete tumor eradication by ER alone (21-month median follow-up).

CONCLUSIONS

Despite a relatively high rate of residual lesions following ESD for previously treated SNADETs, ESD was feasible, and all patients ultimately achieved clinical success. ESD for previously treated SNADETs may represent a reasonable treatment option.