Simple scoring system for the diagnosis of superficial non‐ampullary duodenal epithelial tumors

Background and Aims Differentiating superficial non‐ampullary duodenal epithelial tumors (SNADETs) that harbor malignant potential is important. We developed a simple scoring system and investigated whether it enables the differentiation of low‐grade adenoma and high‐grade adenoma/adenocarcinoma. Patients and Methods We retrospectively enrolled 197 consecutive patients with 207 SNADETs who underwent endoscopic resection at NTT Medical Center Tokyo between March 2016 and May 2019. Endoscopic findings were compared between Vienna Classification (VCL) C3 and C4/5 lesions. A multivariate logistic regression analysis was performed to develop a scoring system to identify VCL C4/5 lesions. The efficacy of our scoring system was elucidated among five novice and five expert endoscopists. Results Of 207 SNADETs, 66 and 141 lesions were pathologically diagnosed as VCL C3 and C4/5. A multivariate logistic regression analysis identified a tumor diameter of 10–19 mm (OR, 3.81; 95% CI, 1.02–14.2; P = 0.04), a tumor diameter ≥20 mm (OR, 95.2; 95% CI, 10.4–871.0; P