Endoscopic Submucosal Dissection Versus Laparoscopic and Endoscopic Cooperative Surgery for Superficial Duodenal...

This study aimed to compare the clinicopathological features and short-term outcomes of endoscopic submucosal dissection (ESD) and laparoscopic and endoscopic cooperative surgery (LECS) for superficial duodenal epithelial tumors (SDETs) and investigate the risk factors for severe adverse events (AEs).

Overall, 1017 patients who underwent ESD and 62 who underwent LECS to treat suspected SDETs between January 2008 and December 2018 were included. After comparing surgical and postsurgical outcomes between the two groups, logistic regression analyses were performed to identify the predictors of AEs.

The lesion size was significantly larger in the LECS group than in the ESD group (28.5 vs. 20.8 mm, p < 0.01). The LECS group included significantly more patients with lesions greater than half the circumference than did the ESD group (19.3% vs. 5.4%, p < 0.01). LECS achieved a significantly higher complete closure rate of the resected wounds (98.4% vs. 74.4%, p < 0.01). Delayed bleeding and perforation occurred in 49 (5.0%) and 22 (2.2%) patients in the ESD group and 3 (4.8%) and 1 (1.6%) in the LECS group, respectively. Multivariate analyses revealed that incomplete closure of the resected wounds was the only independent risk factor for delayed bleeding (odds ratio, 5.069) and delayed perforation (odds ratio, 5.413).

Both ESD and LECS showed similar AE rates, although LECS is likely to be indicated for larger and wider circumferential tumors. Only incomplete closure of the resected wound was an independent risk factor for severe AEs, such as delayed perforation and bleeding.