Certified endoscopists can perform duodenal endoscopic submucosal dissection safely compared to super-experts: a retrospective study of 686 patients with duodenal epithelial neoplasms

Aims In our institution, certified endoscopists perform duodenal endoscopic submucosal dissection (DESD), which is a highly difficult procedure, under the supervise of super-experts. The aim of this study is to investigate the safety and efficacy of DESD performed by certified endoscopists.

Methods This is a single center retrospective study. Between July 2010 and April 2024, 804 ESDs for duodenal epithelial neoplasms in 773 patients were performed. Of these, excluding cases in which two or more lesions were resected in one time or in which papilla was included in the resected lesion, the eligible lesions were divided into a certified endoscopist (CE) group and a super-expert (SE) group according to the experience of the operators. CE was defined as that who have performed less than 50 DESDs and more than 200 ESDs regardless of organ. SE was defined as that who have performed more than 50 DESDs and more than 1000 ESDs regardless of organ. The lesion backgrounds and treatment outcomes were compared between the two groups.

Results 686 lesions in 686 patients were identified. There were 92 lesions in the CE group and 594 lesions in the SE group. There were nine and two operators in the CE and SE groups, respectively. The proportions of lesion location (bulb/superior duodenal angulus/second part/inferior duodenal angulus/third part) in the CE and SE groups were 16%/8%/57%/16%/3% and 17%/10%/49%/17%/7%, respectively. The mean lesion diameter in the CE was smaller than that in the SE group (18±11 vs. 33±19 mm, p<0.01). The proportions of en-bloc resection in the CE and SE group were 97.8% and 99.3% (p=0.18), respectively. The mean time for resection in the CE group was longer than that in the SE group (61±39 vs. 51±41 min, p=0.02). Regarding the wounds that were attempted to be sutured (80% (551/686)), the mean suturing times were 23±24 min in the CE group and 20±14 min in the SE group (p=0.18). The complete suturing success rates were 96% in the CE group and 91% in the SE group (p=0.18). The incidence of intraoperative perforation in the CE group was higher than that in the SE group (12.0% vs. 5.7%, p=0.04). On the other hand, there were no significant differences in the incidence of delayed adverse events between the two groups; delayed bleeding rates were 0% vs. 3.0% (CE vs. SE) (p=0.15) and delayed perforation rates were 0% vs. 0.8% (CE vs. SE) (p=1.0). The mean hospitalization periods in the CE and SE group were 7.2±3.0 and 7.6±5.1 days (p=0.52), respectively. There was no difference in the R0 resection rate between the two groups (88% vs. 88%, p=1.0).

Conclusions The incidence of intraoperative perforation during DESD performed by CE was high, but there were no differences in the R0 resection, delayed adverse events and hospitalization periods between the outcomes of CE and SE, suggesting that CE can perform DESD safely under supervise of SE.

Publication History

Article published online:
27 March 2025