Usefulness of Endoscopic Mucosal Resection Using an Over-the-Scope Clip for Duodenal Neuroendocrine Tumors: A Multicenter Retrospective Comparative Study.

Abstract

Background and aim: Resection of non-ampullary duodenal neuroendocrine tumors presents technical challenges. This study investigated the efficacy and safety of endoscopic mucosal resection using an over-the-scope clip compared to endoscopic mucosal resection with a ligation device and endoscopic submucosal dissection.

Methods: This retrospective multicenter study included 65 lesions (63 patients), categorized by resection method: endoscopic mucosal resection using an over-the-scope clip (n = 26), endoscopic mucosal resection using a ligation device (n = 17), and endoscopic submucosal dissection (n = 22). Patient characteristics, tumor details, and outcomes were systematically evaluated, with significance at p < 0.05.

Results: Endoscopic mucosal resection using an over-the-scope clip had a significantly shorter procedure time than endoscopic submucosal dissection (16 min [7-30] vs. 60 min [28-119], p < 0.001) and recorded no perforations. Endoscopic mucosal resection using a ligation device was employed for smaller lesions, while endoscopic submucosal dissection had challenges in achieving clear margins. Hospitalization duration was the longest for the endoscopic submucosal dissection group (endoscopic mucosal resection using an over-the-scope clip: 4 [3-7] days, endoscopic mucosal resection using a ligation device: 5 [4-8] days, endoscopic submucosal dissection: 7 [4-15] days, p < 0.001). Endoscopic mucosal resection using an over-the-scope clip exhibited a unique advantage for full-thickness resection.

Conclusions: Endoscopic mucosal resection using an over-the-scope clip allows for full-thickness resection with fewer complications. While effective, endoscopic mucosal resection using a ligation device is less reliable for achieving clear vertical margins, and endoscopic submucosal dissection, suitable for larger tumors, has a longer duration and higher complication rate.