Endoscopy 2022; 54(05): 523-524
DOI: 10.1055/a-1669-8863
Letter to the editor

Reply to Lv and Yang

 1   Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
,
Yoji Takeuchi
 2   Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Shu Hoteya
 3   Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
,
Tsuneo Oyama
 4   Department of Endoscopy, Saku Central Hospital Advanced Care Center, Nagano, Japan
,
Satoru Nonaka
 5   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
 6   Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
,
Naomi Kakushima
 7   Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
,
Ken Ohata
 8   Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
,
 9   Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
,
Yuko Hara
10   Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
,
Hisashi Doyama
11   Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
,
Osamu Dohi
12   Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
,
13   Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
,
14   Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
,
Kengo Takimoto
15   Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
,
Koichi Kurahara
16   Division of Gastroenterology, Matsuyama Red Cross Hospital, Matsuyama, Japan
,
Tomoaki Tashima
17   Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
,
Nobutsugu Abe
18   Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
,
Atsushi Nakayama
 1   Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
,
Ichiro Oda
 5   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Naohisa Yahagi
 1   Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
› Author Affiliations

We thank Drs. Lv and Yang for their comments concerning our article “Outcomes of endoscopic resection for superficial duodenal tumors: 10 years’ experience in 18 Japanese high-volume centers” [1].

In this study, we compared resection outcomes of underwater endoscopic mucosal resection (UEMR) and conventional EMR. The en bloc resection rate (78.6 % vs 86.8 %) was significantly lower with UEMR, whereas there was no significant difference in the R0 resection rate (56.0 % vs 61.2 %). For colorectal neoplasms, a randomized controlled trial comparing outcomes of UEMR and EMR reported that UEMR had a higher R0 resection rate than EMR [2]. In the duodenum, there is controversy about the most appropriate resection method between UEMR and EMR, with some reports suggesting the superiority of UEMR [3] [4] and others suggesting superiority of EMR [5]. Omitting submucosal injection would allow easier snaring by shrinking the target mucosa; however, it would impair the visibility of lesions, particularly those located in areas such as behind Kerckring folds and in the flexural part of the duodenum.

Drs. Lv and Yang pointed out that studying the local recurrence rate in smaller lesions is important for appropriate selection of treatment. In our study, the incidence of delayed adverse events following ESD of lesions smaller than 20 mm was 7.4 %, more than three times the incidence for non-ESD lesions (1.9 %). Considering that an en bloc resection rate of nearly 90 % was achieved with non-ESD, we concluded that ESD is not recommended for this population.

Our study provided real-world data concerning duodenal endoscopic treatment through analysis of more than 3000 cases. However, unavoidable bias due to the retrospective study design and differences in patient background are suspected. Thus, further prospective studies, ideally randomized controlled trials directly comparing each treatment, are required.



Publication History

Publication Date:
21 April 2022 (online)

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