Method and timing of resection of superficial non-ampullary duodenal epithelial tumors

Background and Aim Non-ampullary duodenal epithelial tumors (NADET) are rare, and there is no consensus regarding treatment indications and methods for superficial lesions. Records of patients with NADET over a 10-year period were reviewed to clarify the present state of clinical management of superficial NADET. Methods Data related to clinicopathological characteristics, selection of treatment, and outcomes were collected and analyzed. Results Of 95 lesions, 73 were either adenoma or mucosal or submucosal invasive cancers. Half of the patients with a biopsy diagnosis of low-grade adenoma were followed up without treatment. Results of endoscopic resection (ER), including endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) for patients with high-grade adenoma (HGA) or cancer showed a high en bloc resection rate. However, the risk of perforation was high among ESD cases. Surgery was done for patients with a diagnosis of cT1a or cT1b cancer, of which half underwent local resection. An upgrade in pathology between preoperative biopsy and final pathology was observed in 11/13 lesions with a biopsy diagnosis of HGA. Conclusions Superficial NADET, including HGA, should be treated endoscopically or surgically. For lesions with no risk of metastasis, local resection by EMR may be reasonable or clinically sufficient regarding the high complication rate of ESD. However, surgery remains a standard treatment for lesions that are technically impossible to remove by ER.