Use of Dedicated Device Assisted versus Conventional Over-the-Scope-Clip Assisted Endoscopic Full Thickness Resection of Duodenal Sub-epithelial Lesions

Background and Aims: Endoscopic full thickness resection (EFTR) of duodenal sub-epithelial lesions (SEL) is being increasingly performed, in centers where endoscopic removal is considered. We here describe our experience of using two different techniques of EFTR.

Methods: Data of all patients who underwent EFTR for non-metastatic duodenal SELs measuring 10 to 20 mm using either (1) standard over-the-scope-clip (OTSC)-assisted resection or (2) dedicated gastroduodenal full-thickness resection device (FTRD; Ovesco Endoscopy, Tübingen, Germany) assisted resection were analyzed. The primary outcome was technical success, while secondary outcome were adverse events, rate of R0 resection, duration of procedure.

Result: A total of 12 patients underwent EFTR during the study period. In 7 of them conventional OTSC was deployed initially followed by resection using hot-snare polypectomy technique. In 5 patients, dedicated FTRD device was used where one step clip deployment-resection was done. Overall mean size of resected lesion was 15.50 ± 2. 39 mm. Technical success was 100% in both the groups (p = 0.99). R0 resection was achieved in 4 (80.0%) in FTRD group versus 6 (85.7%) in OTSC group (p = 0.26). Procedure duration was 15.34 ± 5.32 minutes in FTRD group versus 27.21 ± 6.55 minutes in OTSC group (p = 0.007) ([Table 1]). Overall adverse events were seen in 3 (25.0%) patients, out of which 1 case of minor bleeding in each group (p = 0.99) and 1 case of slippage of device cap in FTRD group (p = 0.21). No leak was seen in either of the groups.

Conclusion: EFTR by either conventional OTSC-assisted resection or dedicated FTRD device can be done for moderate size duodenal SELs with reasonable safety profile and similar technical success and R0 resection rate. Duration of procedure may be shorter with FTRD device.

Table 1 Describing patient characteristics, technical and clinical parameters among all patients and comparative analysis is shown between FTRD group and OTSC group

Parameters	All patients (n = 12)	FTRD group (n = 5), n (%); mean ± SD	OTSC group (n = 7), n (%); mean ± SD	p-Value
Number of patients	12 (100.0%)	5 (41.7%)	7 (58.3%)	NA
Age (years)	60.35 ± 10.23	56.88 ± 17.02	61.71 ± 5.65	0.49
Gender
Males	7 (58.3%)	4 (80.0%)	3 (42.9%)	0.19
Females	5 (41.7%)	1 (20.0%)	4 (57.1%)
Location of the lesion
D1 anterior	7 (58.3%)	3 (60.0%)	4 (57.1%)	0.84
D1 inferior	2 (16.7%)	1 (20.0%)	1 (14.3%)
D1 posterior	1 (8.3%)	0 (0.0%)	1 (14.3%)
D2 medial	2 (16.7%)	1 (20.0%)	1 (14.3%)
Endoscopic complete resection	12 (100.0%)	5 (100.0%)	7 (100.0%)	0.99
Size of resected specimen (mm)	15.50 ± 2.39	14.60 ± 3.44	16.14 ± 1.21	0.29
R0 resection	10 (83.3%)	4 (80.0%)	6 (85.7%)	0.79
Histology
Neuroendocrine tumor	10 (83.4%)	5 (100.0%)	5 (71.4%)	0.42
Gastrointestinal stromal tumor	1 (8.3%)	0 (0.0%)	1 (14.3%)
Brunner’s gland hyperplasia	1 (8.3%)	0 (0.0%)	1 (14.3%)
Duration of procedure (minutes)	22.27 ± 8.43	15.34 ± 5.32	27.21 ± 6.55	0.007
Adverse event-	3	2	1	0.31
Minor Bleeding Leak	2	1	1	0.79
Slippage of cap	1	1	0	0.21
Follow-up endoscopy (mo)	9.08 ± 8.15	7.20 ± 6.57	10.43 ± 6.55	0.41
Recurrence	0 (0.0%)	0 (0.0%)	0 (0.0%)	0.99

Abbreviations: FTRD, full-thickness resection device; OTSC, over the scope clip.

Publication History

Article published online:
22 April 2024