Duodenal ESD and EFTR: GIE | October 2026

What Did the Study Find?

This real-world study evaluated 109 duodenal resections in 101 patients undergoing endoscopic submucosal dissection (ESD) or free-hand endoscopic full-thickness resection (EFTR) between 2020 and 2025.

• Technical success was 98.2%, demonstrating feasibility in experienced hands.
• R0 resection rates were high: 93.3% for epithelial lesions and 90.4% for subepithelial lesions.
• EFTR was required in 17% of subepithelial lesions, primarily because of deep invasion or severe fibrosis.
• Intraprocedural bleeding occurred in 16.5% and perforation in 5.5%, with all perforations managed endoscopically.
• Severe fibrosis was the strongest independent predictor of procedural adverse events in subepithelial lesions (OR 20.51).
• Ulceration was significantly associated with severe fibrosis (OR 5.09), potentially identifying technically difficult lesions.
• Complete defect closure was achieved in 97.2%, with delayed adverse events occurring in only 2.8%.
• During a median follow-up of 15.3 months, local recurrence was 2.1%, limited to neuroendocrine tumors.

Why Does It Matter?

The duodenum remains one of the most challenging locations for advanced endoscopic resection because of its thin wall, vascularity and exposure to pancreaticobiliary secretions.

This study suggests that careful lesion selection, recognition of fibrosis and systematic defect closure may enable effective duodenal ESD and EFTR while limiting delayed complications.

GastroAGI Takeaway

The success of advanced duodenal resection depends not only on removing the lesion but also on safely closing the defect.

A structured closure strategy was associated with 97.2% complete closure and only 2.8% delayed adverse events, supporting its incorporation into expert-center practice.

Severe fibrosis—particularly when accompanied by ulceration—should alert endoscopists to substantially greater procedural risk.