ArticleSurgical endoscopy2026
Outpatient endoscopic submucosal dissection for non-ampullary duodenal lesions: a single-center experience at a U.S. tertiary referral center.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionEndoscopic submucosal dissection (ESD) offers significant advantages, including the potential for curative resection of early-stage neoplasms. Despite this, the application of ESD for treating duodenal lesions remains sparse, particularly in the Western region. We aim to determine the feasibility of outpatient duodenal ESD from a tertiary referral center experience in the United States.
methodsConsecutive patients undergoing duodenal ESD from 2019 to 2024 at a tertiary referral center were included. The primary outcomes were the rate of en-bloc resection and curative resection. The secondary outcomes were the adverse event rate, including perforation or bleeding. Cohorts were compared using Chi-square, Fischer exact test, and logistic regression.
resultsThe study included 37 patients (57% females) with a mean age of 67 years (SD: 12). The mean diameter of the lesions was 39.1 mm (SD: 27.2), of which 54% (n = 20) were adenomatous lesions followed by 46% (n = 17) neuroendocrine lesions. All cases performed in an outpatient setting. Overall, 81% (n = 30) of lesions were removed by en-bloc resection, with a 67.6% (n = 25) R0 resection rate. Closure was performed in 68% (n = 25) of lesions. The adverse event rate was 5%, with two cases of delayed bleeding reported and no cases of delayed perforation. Mean resection time was 60 min (± 39 min). No significant difference was noted in en-bloc resection of adenomatous vs neuroendocrine tumors (69.6% vs 100%, P = 0.638) or R0 resection (69.6% vs 64%, P = 0.085), respectively.
conclusionWhen performed by very experienced endoscopists, duodenal ESD can be performed effectively and safely for non-ampullary duodenal lesions, achieving high en-bloc resection rates with low adverse event rates. Defect closure may help mitigate delayed adverse events, supporting the feasibility of outpatient duodenal ESD.
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