C0455 - Duodenal Endoscopic Submucosal Dissection in the United States: A Single Center Case Series

Kana Chin, MD, Makoto Nishimura, MD, Sera Satoi, MD, Jacques C. Beauvais, MD, Mark Schattner, MD
Memorial Sloan Kettering Cancer Center, New York, NY

Introduction: Endoscopic Submucosal Dissection (ESD) is a well-established effective endoscopic technique which facilitates en bloc removal of gastrointestinal epithelial lesions. Duodenal ESD is a relatively novel and rare procedure in the United States (US). Here we report a single-center case series of duodenal ESD in the US.

Methods: Patients who received ESD at Memorial Sloan Kettering Cancer Center from June 2018 to May 2022 were reviewed (n=477) and a total of 29 patients who had duodenal ESD were included in this study. Gender, age, American Society of Anesthesiology (ASA) score, type of sedation, type of solution for submucosal lifting agents, procedure time, location of the lesion, en bloc resection rate, R0 (complete) resection rate, presence of scar, adverse events, final pathology, and the length of hospital stay were reviewed.

Results: A total of 29 patients had duodenal ESD (6.0%). 13 were female (44.8%), 16 were male (55.2%) and the median age was 68 (range 40 – 79). 25 cases (86.2%) had adenoma, 3 cases (10.3%) had neuroendocrine tumor and 1 had no tumor in the final pathology report. 23 were performed under general anesthesia (79.3%) and 6 with propofol sedation (20.7%). 10 patients (34.5%) were classified ASA Ⅱ and 19 patients (65.5%) were ASA Ⅲ. The location of lesions was 2nd part (15/29, 51.7%), followed by 3rd part (10/29, 34.5%), 1st part and bulb (3/29, 10.3%). En bloc resection was achieved in 14 cases (48.3%) and 3 had post-endoscopic mucosal resection (EMR)/ polypectomy scars (3/14, 21.4%). R0 resection rate was 44.8% (13 cases). Of 15 of piecemeal resections (51.7%), 4 had post-EMR/ polypectomy scars (4/15, 26.7%). En bloc and piecemeal resection rate were not affected by the presence of scars (p=0.35). ORISE was used in 16 cases (55.2%) and Eleview was used in 13 cases (44.8%) as the lifting solution and en bloc resection rate was 50% (8/16) with ORISE cases and 46.2% (6/13) in Eleview cases. Mean procedure time was 119 minutes (range 24 -240). As a complication, no perforations were noted. 1 patient developed post-ESD pancreatitis after the removal of large adenoma involving ampulla. The median length of hospital stay was 2 days (range 0 - 20).

Discussion: This study demonstrated that the duodenal ESD is safe and feasible in the US. The current task is to increase more skilled endoscopists for ESD procedures. Further studies with a larger population are necessary to investigate safety and efficacy in the US.



Disclosures:


Kana Chin, MD, Makoto Nishimura, MD, Sera Satoi, MD, Jacques C. Beauvais, MD, Mark Schattner, MD. C0455 - Duodenal Endoscopic Submucosal Dissection in the United States: A Single Center Case Series, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.