The mucin phenotype does not affect the endoscopic resection outcome of non-ampullary duodenal epithelial tumors

Abstract

Background and study aims Some studies have reported an association between clinicopathological features and mucin phenotypes of non-ampullary duodenal epithelial tumors (NADETs). However, the association between clinical outcomes of endoscopic resection (ER) and mucin phenotypes has not been elucidated. The aim of this retrospective study was to analyze clinical outcomes of ER of NADETs with reference to mucin phenotypes.

Patients and methods We retrospectively evaluated the clinical outcomes of ER for NADETs performed from 2006 to 2019 and compared clinicopathological characteristics, ER procedures, and outcomes, including adverse events (AEs) among tumors classified by mucin phenotype. Mucin phenotypes were classified as gastric, gastrointestinal, and intestinal based on immunohistochemical examination. Grade of dysplasia was determined according to the Vienna classification (VCL).

Results The proportion of VCL 4/5 was higher in the gastric type (50 %) compared with that in the gastrointestinal (39.1 %, P = 0.009) and intestinal types (5.4 %, P = 0.008), respectively. With no statistical difference in tumor size and ER method among the three groups, no significant difference was observed for ER outcomes, i. e., en bloc and R0 resection rates. In the gastrointestinal and intestinal types, AEs occurred in four cases treated with ESD, but none developed in the gastric type.

Conclusions This study suggests that the mucin phenotype does not affect resection outcome. However, considering high malignant potential and tendency for low AE rates, the gastric type NADETs may be more appropriate for proactive ER than the others.

Publikationsverlauf

Eingereicht: 22. Dezember 2020

Angenommen: 08. März 2021

Artikel online veröffentlicht:
16. August 2021

• References

• 1 Endo M, Abiko Y, Oana S. et al. Usefulness of endoscopic treatment for duodenal adenoma. Dig Endosc 2010; 22: 360-365
• 2 Nonaka S, Oda I, Tada K. et al. Clinical outcome of endoscopic resection for nonampullary duodenal tumors. Endoscopy 2015; 47: 129-135
• 3 Inoue T, Uedo N, Yamashina T. et al. Delayed perforation: a hazardous complication of endoscopic resection for non-ampullary duodenal neoplasm. Dig Endosc 2014; 26: 220-227
• 4 Ochiai Y, Kato M, Kiguchi Y. et al. Current status and challenges of endoscopic treatment for duodenal tumors. Digestion 2019; 99: 21-26
• 5 Maruoka D, Matsumura T, Kasamatsu S. et al. Cold polypectomy for duodenal adenomas: a prospective clinical trial. Endoscopy 2017; 49: 776-783
• 6 Yamasaki Y, Uedo N, Takeuchi Y. et al. Underwater endoscopic mucosal resection for superficial nonampullary duodenal adenomas. Endoscopy 2018; 50: 154-158
• 7 Iwagami H, Takeuchi Y, Yamasaki Y. et al. Feasibility of underwater endoscopic mucosal resection and management of residues for superficial non-ampullary duodenal epithelial neoplasms. Dig Endosc 2020; 32: 565-573
• 8 Yamasaki Y, Takeuchi Y, Uedo N. et al. Line-assisted complete closure of duodenal mucosal defects after underwater endoscopic mucosal resection. Endoscopy 2017; 49: E37-E38
• 9 Fukuhara S, Kato M, Iwasaki E. et al. Management of perforation related to endoscopic submucosal dissection for superficial duodenal epithelial tumors. Gastrointest Endosc 2020; 91: 1129-1137
• 10 Tashima T, Ohata K, Sakai E. et al. Efficacy of an over-the-scope clip to overcome the problem. Scope clip for preventing adverse events after duodenal endoscopic submucosal dissection: a prospective interventional study. Endoscopy 2018; 50: 487-496
• 11 Dohi O, Yoshida N, Naito Y. et al. Efficacy and safety of endoscopic submucosal dissection using a scissors-type knife with prophylactic over-the-scope clip closure for superficial non-ampullary duodenal epithelial tumors. Dig Endosc 2020; 32: 904-913
• 12 Toba T, Inoshita N, Kaise M. et al. Clinicopathological features of superficial non-ampullary duodenal epithelial tumor; gastric phenotype of histology correlates to higher malignant potency. J Gastroenterol 2018; 53: 64-70
• 13 Mitsuishi T, Hamatani S, Hirooka S. et al. Clinicopathological characteristics of duodenal epithelial neoplasms: Focus on tumors with a gastric mucin phenotype (pyloric gland-type tumors). PLoS One 2017; 12: e0174985
• 14 Toya Y, Endo M, Akasaka R. et al. Clinicopathological features and magnifying chromoendoscopic findings of non-ampullary duodenal epithelial tumors. Digestion 2018; 97: 219-227
• 15 Minatsuki C, Yamamichi N, Inada K. et al. Expression of gastric markers is associated with malignant potential of nonampillary duodenal adenocarcinoma. Dig Dis Sci 2018; 63: 2617-2625
• 16 Yoshida M, Shimoda T, Abe M. et al. Clinicopathological characteristics of non-ampullary duodenal tumors and their phenotypic classification. Pathol Int 2019; 69: 398-406
• 17 Akazawa Y, Ueyama H, Tsuyama S. et al. Endoscopic and clinicopathological features of superficial non-ampullary duodenal tumor based on the mucin phenotypes. Digestion 2020; 1-8 Online ahead of print.
• 18 Matsueda K, Uedo N, Kitamura M. et al. Pre-ampullary location and size ≥ 10mm are independent predictors for high-grade superficial non-ampullary duodenal epithelial tumors. J Gastroenterol Hepatol 2020;
• 19 Tomizawa Y, Ginsberg GG. Clinical outcome of EMR of sporadic, nonampullary, duodenal adenomas: a 10-year retrospective. Gastrointest Endosc 2018; 87: 1270-1278
• 20 Valerii G, Tringali A, Landi R. et al. Endoscopic mucosal resection of non-ampullary sporadic duodenal adenomas: a retrospective analysis with long-term follow up. Scand J Gastroenterol 2018; 53: 490-494
• 21 Hara Y, Goda K, Dobashi A. et al. Short- and long-term outcomes of endoscopically treated superficial non-ampullary duodenal epithelial tumors. World J Gastroenterol 2019; 25: 707-718
• 22 Hwang KL, Kim GH, Lee BE. et al. Long-term outcomes of endoscopic resection for non-ampullary duodenal epithelial tumors: A single-center experience. Turk J Gastroenterol 2020; 1: 49-57
• 23 Dixon MF. Gastrointestinal epithelial neoplasia: Vienna revised. Gut 2002; 51: 130-131
• 24 Toya Y, Endo M, Oizumi T. et al. Diagnostic algorithm of magnifying endoscopy with crystal violet staining for non-ampullary duodenal epithelial tumors. Dig Endosc 2020; 32: 1066-1073
• 25 Kobayashi M, Takeuchi M, Ajioka Y. et al. Mucin phenotype and narrow-band imaging with magnifying endoscopy for differentiated-type mucosal gastric cancer. J Gastroenterol 2011; 46: 1064-1070
• 26 Yao T, Takata M, Tustsumi S. et al. Phenotypic expression of gastrointestinal differentiation markers in colorectal adenocarcinomas with liver metastasis. Pathology 2002; 34: 556-560
• 27 Yahagi N, Kato M, Ochiai Y. et al. Outcomes of endoscopic resection for superficial duodenal epithelial neoplasia. Gastrointest Endosc 2018; 88: 676-682
• 28 Hoteya S, Furuhata T, Takahito T. et al. Endoscopic submucosal dissection and endoscopic mucosal resection for non-ampullary superficial duodenal tumor. Digestion 2017; 95: 36-42
• 29 Kanaji S, Morita Y, Yamazaki Y. et al. Feasibility of laparoscopic endoscopic cooperative surgery for non-ampullary superficial duodenal neoplasms: single-arm confirmatory trial. Dig Endosc 2020; 33: 373-380