A feasibility study of an advanced therapeutic procedure for large duodenal lesions including papilla

Background and aim: We developed an advanced therapeutic procedure for large duodenal lesions including papilla, endoscopic submucosal dissection including papilla (ESDIP), and evaluated the feasibility of ESDIP in this study.
Method: This was a retrospective observational study. We included consecutive patients underwent ESDIP from 2010 to 2021 in this study. We analyzed the patient characteristics, treatment result, pathological result, and long-term prognosis. Treatment outcomes were analyzed in two periods, depending on the number of cases.
Results: Thirty-two patients were treated in total. The mean age was 61±12 years old. The mean lesion size was 35±15mm. The mean procedure time was 70±43min. Treatment Completion Rate was 94%. En bloc resection rate in completed treatment cases was 100%. Overall intraprocedural perforation rate was 20%. However, there was no intraprocedural perforation case in the second half. Overall rate of delayed bleeding and delayed perforation was 17% and 0% respectively. In the pathological diagnosis, one-third was Vienna classification (VCL) 5, and the others were VCL3/4. R0 resection rate was 47%. The overall local recurrence rate was 17%, and all recurrent cases had positive or indistinct resection margins at the papilla.
Conclusion: ESDIP is feasible and has the potential to avoid pancreaticoduodenectomy, however, securing the resection margin at the papilla remains a challenge.