Supplementary Material for: The Characteristics and Treatment Outcomes of 71 Duodenal Brunner’s gland Adenomas with Endoscopic Submucosal Dissection

Abstract Background: The aim of this study was to investigate outcomes of patients with duodenal Brunner’s gland adenomas (BGAs) that were treated endoscopically. Methods: We identified consecutive 71 patients treated at our center with endoscopic submucosal dissection (ESD) for their duodenal tumors diagnosed pathologically as BGAs over the period between January 1, 2011 and December 31, 2021. We retrospectively analyzed our experience and short- and long-term outcomes of ESD therapy on patients with BGAs. Results: Among 71 BGA patients with an average age of 57 ± 11.7 years (range: 30-82), 48 (67.6%) were male and 23 (32.4%) were female. The accuracy of preoperative diagnosis with endoscopic ultrasonography was 44.0% (22/50). The H. pylori infection was found in 29 patients (29/71, 40.8%). The median size of BGAs was 1.5 cm [interquartile range (IQR) 0.8-2.7cm]. The most common location was the duodenum bulb (50/71, 64.8%). For the ESD procedure, the median operation time was 15.0 minutes (IQR 9.5-25.5 minutes). The en-bloc and the complete resection rates were 97.2% and 92.3%, respectively. ESD-related mild acute obstructive pancreatitis was present in two patients (2/4, 50%) with BGAs located in the ampulla region. During the follow-up period, one patient with a positive peripheral margin experienced tumor recurrence 2 years after the initial ESD. There was no disease-related death for the cohort. Conclusion: ESD was an effective and safe therapeutic option for BGA patients with excellent outcomes. Long-term follow-up is needed.【背景】本研究旨在探讨内镜治疗十二指肠Brunner腺腺瘤（duodenal Brunner’s gland adenomas, BGAs）患者的临床结局。【方法】本研究纳入2011年1月1日至2021年12月31日期间，在本中心接受内镜黏膜下剥离术（endoscopic submucosal dissection, ESD）治疗、经病理确诊为BGAs的71例连续性十二指肠肿瘤患者，回顾性分析该队列的诊疗经验及ESD治疗的短期与长期临床结局。【结果】71例BGA患者的平均年龄为57±11.7岁，年龄范围30~82岁，其中男性48例（占比67.6%），女性23例（占比32.4%）。术前内镜超声（endoscopic ultrasonography）诊断准确率为44.0%（22/50）。29例患者检出幽门螺杆菌（H. pylori）感染（占比40.8%）。BGAs的中位直径为1.5 cm [四分位间距（interquartile range, IQR）0.8~2.7 cm]。最常见的发病部位为十二指肠球部（50/71，占比64.8%）。ESD手术的中位操作时间为15.0分钟（IQR 9.5~25.5分钟）。整块切除率与完全切除率分别为97.2%和92.3%。2例位于壶腹区域的BGAs患者出现ESD相关的轻度急性梗阻性胰腺炎（占该亚组的50%，2/4）。随访期间，1例切缘阳性的患者在初始ESD治疗2年后出现肿瘤复发。本队列无疾病相关死亡病例。【结论】ESD是治疗BGAs患者安全有效的治疗选择，临床结局优异，需长期随访监测。