Endoscopic resection of large sporadic non-ampullary duodenal polyps: efficacy and long-term recurrence

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Abstract

Endoscopic resection is an alternative to surgery for removal of large duodenal polyps. There are limited data on the safety, efficacy, and long-term recurrence data after endoscopic resection of sporadic, non-ampullary, and large duodenal polyps.

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Most cited references 16

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Endoscopic resection of sporadic duodenal adenomas: an efficient technique with a substantial risk of delayed bleeding.

V Lepilliez, M Chemaly, T. Ponchon … (2008)

Data on endoscopic resection of sporadic duodenal adenoma (SDA) are sparse; we present our results concerning safety and efficacy in a retrospective analysis of saline-assisted endoscopic resection of SDA.

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Evidence for adenoma-carcinoma sequence in the duodenum of patients with familial adenomatous polyposis. The Leeds Castle Polyposis Group (Upper Gastrointestinal Committee).

Leslie C. Costello, Manoel Penna, I Talbot … (1994)

To explore the association between duodenal adenoma and carcinoma in patients with familial adenomatous polyposis (FAP). A multicentre survey of 1262 patients with FAP yielded 47 cases of duodenal cancer. The association between adenoma and cancer was assessed in these cases. Adenomatous tissue was found within duodenal cancer in 29 of 44 (66%) patients with FAP and in mucosa adjacent to duodenal cancer in 31 of 42 (73%) such patients. Adenomas were found as a component of, or adjacent to, duodenal cancer in 38 of 45 (84%) patients. These observations support the existence of the adenomacarcinoma sequence in the duodenum of patients with FAP. Factors associated with malignant change included villous histology, moderate or severe dysplasia, and the presence of stage IV duodenal polyposis.

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EMR of large, sessile, sporadic nonampullary duodenal adenomas: technical aspects and long-term outcome (with videos).

S. Williams, Stephen Bourke, Jason A. Bailey … (2008)

EMR is a viable alternative to surgery for removal of large mucosal neoplastic lesions of the entire GI tract. Few studies have, however, been published on the safety, efficacy, and technical aspects of EMR in the duodenum. Our purpose was to evaluate the efficacy and safety of EMR of large (>15 mm) duodenal adenomas. Retrospective evaluation of a defined patient cohort. Tertiary academic referral center. Patients with large (>15 mm) sporadic nonampullary duodenal adenomas managed by a standardized technique who were referred by other specialist endoscopists for endoscopic treatment. Five-year data from patients undergoing EMR for large duodenal adenomas were reviewed retrospectively. Immediate and delayed complications were recorded. Twenty-one lesions were removed by EMR in 23 patients (mean age 62.2 years, 13 female, 10 male). The mean size of lesions resected was 27.6 mm (median 20 mm, range 15-60 mm). Post-EMR histologic examination revealed mucosal adenocarcinoma in 1, low-grade tubulovillous adenoma (TVA) in 16, high- or focal high-grade TVA in 3 patients, and 1 with both high-grade TVA and carcinoid. EMR was performed successfully in 18 patients during a single session. Two patients required 2 sessions and 1 required 3 sessions for complete resection. The median follow-up was 13 months (range 4-44 months). During follow-up, 5 patients had minor residual adenomas that were treated successfully with snare resection and/or argon plasma coagulation. One patient had EMR site bleeding. There were no perforations. Retrospective study. EMR for large sporadic nonampullary duodenal adenomas is a safe and effective technique.