Exposed versus nonexposed endoscopic full-thickness resection for duodenal subepithelial lesions: a tertiary care center experience (with videos)

Background and AimsEndoscopic full-thickness resection (EFTR) has been shown to be effective in selected lesions located in the stomach and colorectum. Data regarding the feasibility, safety, and efficacy of EFTR in the duodenum are limited. In this study, we aimed to evaluate the feasibility and safety of exposed and nonexposed EFTR in patients with large (≥10 mm) duodenal subepithelial lesions.MethodsData of all patients who underwent EFTR for duodenal subepithelial lesions with exposed and nonexposed (device-assisted) techniques were analyzed, retrospectively. The primary outcome of the study was technical success of EFTR in the duodenum. Secondary outcomes were adverse events, R0 resection, and recurrence at follow-up.ResultsTwenty patients with duodenal subepithelial lesions (mean size, 14.2 ± 3.6 mm) underwent EFTR during the study period. Exposed and nonexposed EFTRs were performed in 11 and 9 patients, respectively. The mean procedure duration was 70.3 ± 46.5 minutes. Technical success with exposed and nonexposed techniques was 100% and 75%, respectively. Histologically complete resection (R0) was achieved in 15 patients (75%). Moderate and severe adverse events were recorded in 3 patients, including a leak in 2 patients and partial obstruction of the lumen in 1 patient.ConclusionsEFTR is feasible in large duodenal subepithelial lesions with a reasonable safety profile. EFTR enables complete resection in most duodenal subepithelial lesions. Endoscopic full-thickness resection (EFTR) has been shown to be effective in selected lesions located in the stomach and colorectum. Data regarding the feasibility, safety, and efficacy of EFTR in the duodenum are limited. In this study, we aimed to evaluate the feasibility and safety of exposed and nonexposed EFTR in patients with large (≥10 mm) duodenal subepithelial lesions. Data of all patients who underwent EFTR for duodenal subepithelial lesions with exposed and nonexposed (device-assisted) techniques were analyzed, retrospectively. The primary outcome of the study was technical success of EFTR in the duodenum. Secondary outcomes were adverse events, R0 resection, and recurrence at follow-up. Twenty patients with duodenal subepithelial lesions (mean size, 14.2 ± 3.6 mm) underwent EFTR during the study period. Exposed and nonexposed EFTRs were performed in 11 and 9 patients, respectively. The mean procedure duration was 70.3 ± 46.5 minutes. Technical success with exposed and nonexposed techniques was 100% and 75%, respectively. Histologically complete resection (R0) was achieved in 15 patients (75%). Moderate and severe adverse events were recorded in 3 patients, including a leak in 2 patients and partial obstruction of the lumen in 1 patient. EFTR is feasible in large duodenal subepithelial lesions with a reasonable safety profile. EFTR enables complete resection in most duodenal subepithelial lesions.