Outcomes and Limitations of Duodenal Endoscopic Submucosal Dissection in the United States.

BACKGROUND AND AIMS: Endoscopic submucosal dissection (ESD) of duodenal tumors is challenging due to its unique anatomy and high risk of adverse events. Its use is limited in the United States due to procedural complexity. Our study highlights the feasibility of ESD for managing duodenal tumors in the US.

METHODS

This retrospective cohort included duodenal ESD lesions at two tertiary US medical centers from 2017 to 2024. The primary outcomes included technical success, en bloc, R0, and curative resection rates. Secondary outcomes were adverse events and recurrence rates.

RESULTS

Seventy-four duodenal lesions in 70 patients were resected by three endoscopists with variable levels of experience in ESD. Most lesions (56%) were located in the duodenal bulb. Technical success was 100%, with en bloc and R0 resection rates of 78.3% and 51.4%, respectively. Mean procedure time was 85.9 ± 50.4 min. Neuroendocrine tumors had higher en bloc (90% vs. 62.5%) but lower R0 resection rates (43.8% vs. 53.1%) than adenomas. Adenomas had more positive lateral margins (50% vs. 18.3%). Larger lesions (> 30 mm) had lower en bloc resection rates than smaller ones (≤ 30 mm). The overall adverse event rate was 25.7%. Intraprocedural deep muscle injury and bleeding were more common in lesions > 3 cm (18.2% and 6%) than in smaller lesions (7.3% and 2.4%).

CONCLUSIONS

Duodenal ESD has lower en-bloc and R0 resection rates, but higher risk of adverse events compared to other sites. An individualized approach and careful discussion of endoscopic versus non-endoscopic options with every patient is warranted.