Introduction: Sporadic duodenal adenomas (SDAs) are infrequently encountered and are usually incidental. However, these lesions harbor a malignant potential similar to colonic adenomas. Surgical resection is associated with significant morbidity and mortality. Endoscopic mucosal resection (EMR) is effective and safe for the removal of large colonic adenomas and in recent years has gained acceptance in the treatment of SDAs. However, major complications are much more frequent and adenoma recurrence is reported in up to 37% of cases. Aim: To evaluate the outcomes of EMR for the treatment of SDAs in an Australian tertiary referral centre. Methods: A Retrospective analysis of a prospectively collected database of patients, who underwent EMR of SDAs at a tertiary endoscopy center was performed. Data collection included patients clinical data, lesion characteristics, procedure related data, and results of endoscopic follow-up. Results: Seventy-one SDAs were resected by EMR between June 2005 and February 2014 (mean patient age 65 years, 56% male, median lesions size 25 mm (IQR 15-40 mm)). Pre EMR biopsy was performed in 69.6%. Following EMR the histology was unchanged in 70%, upgraded in 26%, downgraded or revealed a different pathology in 2% each, respectively. Pre-EMR biopsy was not associated with procedure complications, incomplete resection, and recurrence/residual adenoma. Complete endoscopic resection was achieved in 93.5%. Intraprocedural bleeding occurred in 40.8%, did not require intervention in 65% of cases and was not correlated with delayed bleeding. However it was associated with lesion size (p = .02). Delayed bleeding occurred in 13% (93% of these did not need active intervention) and on multivariate analysis was associated with number of resected specimens (OR 1.1/specimen; p = .04) and lesion size (OR 1.1/10 mm; p < 0.01). The admission rate was 31.2% of which 54.2% were due to a procedure related complication. Perforation occurred in 2 patients of which one required surgery. The 30 day mortality was 0%. Mean follow up duration was 16 months and patients had a median of one follow-up endoscopy (IQR 1-2). Histologically confirmed recurrence/residual adenoma was seen and treated in 7/57 (12%) patients on first surveillance endoscopy. Of these, only one persistent residual adenoma was seen on further surveillance. Of 25 patients where ≥2 or more follow-up endoscopies were available, only one persistent recurrence was found. Overall, endoscopic and histological residual/recurrence occurred in 14.5% and 10.0%, respectively. This was successfully treated in 90%. Conclusions: In a tertiary referral centre, EMR of SDAs is a safe and effective alternative to surgery. Pre-EMR biopsies appear not to contribute to the patient's management. Intra-procedural bleeding does not predict further complications. Delayed bleeding is associated with lesion size and number of resected specimens. A structured surveillance program is essential, recurrence is uncommon and can be easily treated endoscopically. Endoscopic ultra...
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