BACKGROUND: EMR is an effective alternative to surgery for the removal of nonampullary duodenal polyps (NADPs). Cap-assisted EMR (EMR-C) has been rarely performed in the duodenum because of the risk of perforation. OBJECTIVE: To evaluate the safety and effectiveness of EMR-C for the removal of large (≥ 15 mm) NADPs. DESIGN: Retrospective study. SETTING: Tertiary-care referral center. PATIENTS: Between 2000 and 2010, 26 consecutive patients with sporadic NADPs underwent EMR-C. INTERVENTION: EMR with the cap technique. MAIN OUTCOME MEASUREMENTS: Complete eradication of polyps, complications, and recurrence. RESULTS: A total of 14 sessile polyps (53.8%), 7 lateral spreading type nongranular tumors (26.9%), and 5 lateral spreading type granular tumors (19.2%) were treated. The median size of lesions was 15 mm. Five lesions involved one-half of the luminal circumference. Post-EMR histologic assessment showed low-grade dysplasia in 5 patients (19.2%) and high-grade dysplasia in 18 patients (69.2%). Three patients (11.5%) had well-differentiated endocrine tumors. Complete eradication was obtained in 25 of 26 (96%) patients. No perforations occurred. Three cases of intraprocedural bleeding were managed endoscopically. Median follow-up was 6 years (range 1-10 years). Residual adenomatous tissue was observed in 3 patients in lesions of 50 mm. In one of these cases, an adenocarcinoma occurred after 8 months, which was managed surgically. LIMITATIONS: Retrospective design, single center. CONCLUSION: This study supports the efficacy and safety of EMR-C for removing NADPs. Regular follow-up is mandatory because of the high risk of residual or recurrent adenomatous tissue and even cancer.
BACKGROUND: EMR is an effective alternative to surgery for the removal of nonampullary duodenal polyps (NADPs). Cap-assisted EMR (EMR-C) has been rarely performed in the duodenum because of the risk of perforation. OBJECTIVE: To evaluate the safety and effectiveness of EMR-C for the removal of large (≥ 15 mm) NADPs. DESIGN: Retrospective study. SETTING: Tertiary-care referral center. PATIENTS: Between 2000 and 2010, 26 consecutive patients with sporadic NADPs underwent EMR-C. INTERVENTION: EMR with the cap technique. MAIN OUTCOME MEASUREMENTS: Complete eradication of polyps, complications, and recurrence. RESULTS: A total of 14 sessile polyps (53.8%), 7 lateral spreading type nongranular tumors (26.9%), and 5 lateral spreading type granular tumors (19.2%) were treated. The median size of lesions was 15 mm. Five lesions involved one-half of the luminal circumference. Post-EMR histologic assessment showed low-grade dysplasia in 5 patients (19.2%) and high-grade dysplasia in 18 patients (69.2%). Three patients (11.5%) had well-differentiated endocrine tumors. Complete eradication was obtained in 25 of 26 (96%) patients. No perforations occurred. Three cases of intraprocedural bleeding were managed endoscopically. Median follow-up was 6 years (range 1-10 years). Residual adenomatous tissue was observed in 3 patients in lesions of 50 mm. In one of these cases, an adenocarcinoma occurred after 8 months, which was managed surgically. LIMITATIONS: Retrospective design, single center. CONCLUSION: This study supports the efficacy and safety of EMR-C for removing NADPs. Regular follow-up is mandatory because of the high risk of residual or recurrent adenomatous tissue and even cancer.
Authors: Raf Bisschops; Miguel Areia; Emmanuel Coron; Daniela Dobru; Bernd Kaskas; Roman Kuvaev; Oliver Pech; Krish Ragunath; Bas Weusten; Pietro Familiari; Dirk Domagk; Roland Valori; Michal F Kaminski; Cristiano Spada; Michael Bretthauer; Cathy Bennett; Carlo Senore; Mário Dinis-Ribeiro; Matthew D Rutter Journal: United European Gastroenterol J Date: 2016-08-21 Impact factor: 4.623
Authors: Peter John Basford; Regi George; Emma Nixon; Tehreem Chaudhuri; Rob Mead; Pradeep Bhandari Journal: Surg Endosc Date: 2014-01-18 Impact factor: 4.584
Authors: Udayakumar Navaneethan; Muhammad K Hasan; Vennisvasanth Lourdusamy; Xiang Zhu; Robert H Hawes; Shyam Varadarajulu Journal: Endosc Int Open Date: 2016-06
Authors: Maxime Amoyel; Arthur Belle; Marion Dhooge; Einas Abou Ali; Rachel Hallit; Frederic Prat; Anthony Dohan; Benoit Terris; Stanislas Chaussade; Romain Coriat; Maximilien Barret Journal: Endosc Int Open Date: 2022-01-14