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Masanori Furukawa,Akira Mitoro,Takahiro Ozutumi,Yukihisa Fujinaga,Keisuke Nakanishi,Koh Kitagawa,Soichiro Saikawa,Sinya Sato,Yasuhiko Sawada,Hiroaki Takaya,Kosuke Kaji,Hideto Kawaratani,Tadashi Namisa 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.3
Background/Aims: Endoscopic resection (ER) for superficial non-ampullary duodenal epithelial tumors (SNADETs) is challenging. Conventional endoscopic mucosal resection (CEMR) is also problematic due to the anatomical features of the duodenum. Wecompared the safety and efficacy of underwater endoscopic mucosal resection (UEMR) with those of CEMR through a retrospectiveanalysis. Methods: Altogether, 44 consecutive patients with 46 SNADETs underwent ER (18 CEMR cases and 28 UEMR cases) betweenJanuary 2016 and October 2019. We investigated the proportions of en bloc resection, R0 resection, complications, resection time,and total procedure time and compared the outcomes of patients from the CEMR group with those of patients from the UEMRgroup. Results: The median tumor size was 8.0 mm (range, 2.0–20.0 mm). The UEMR group showed a higher proportion of en blocresection (96.4% vs. 72.2%, p<0.05) and significantly lower median resection time and total procedure time (4 min vs. 9.5 min,p<0.05 and 13 min vs. 19 min, p<0.05; respectively) than the CEMR group. No complications were observed. However, two patientstreated with piecemeal resection in the CEMR group had residual tumors. Conclusions: UEMR is a feasible therapeutic option for SNADETs. It can be recommended as a standard treatment.
Koh Kitagawa,Akira Mitoro,Takahiro Ozutsumi,Masanori Furukawa,Yukihisa Fujinaga,Kenichiro Seki,Norihisa Nishimura,Yasuhiko Sawada,Kosuke Kaji,Hideto Kawaratani,Hiroaki Takaya,Kei Moriya,Tadashi Namisa 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.3
Background/Aims: Covered self-expandable metallic stents (CMSs) are widely used for malignant distal biliary obstructions (MDBOs)caused by pancreatic carcinoma. This study compared the efficacy and safety of the laser-cut-type and braided-type CMSs. Methods: To palliate MDBOs caused by pancreatic carcinoma, the laser-cut-type CMSs was used from April 2014 to March 2017, andthe braided-type CMSs was used from April 2017 to March 2019. The tested self-expandable metallic stents were equipped with differentanti-migration systems. Results: In total, 47 patients received CMSs for MDBOs (24 laser-cut type, 23 braided-type). The time to recurrent biliary obstruction(TRBO) was significantly longer in the braided-type CMSs (p=0.0008), and the median time to stent dysfunction or patient death was141 and 265 days in the laser-cut-type CMSs and braided-type CMSs, respectively (p=0.0023). Stent migration was the major cause ofstent dysfunction in both groups, which occurred in 37.5% of the laser-cut-type CMSs and 13.0% of the braided-type CMSs. Therewere no differences in the survival duration between the groups. Conclusions: The TRBO was significantly longer for the braided-type CMSs with an anti-migration system than for the laser-cut-type. Stent migration tended to be less frequent with the braided-type CMSs than with the laser-cut-type CMSs.