Clinical outcome of EMR of sporadic, nonampullary, duodenal adenomas: a 10-year retrospective

Tomizawa, Yutaka; Ginsberg, Gregory G.

doi:10.1016/j.gie.2017.12.026

Cited by 58 publications

(62 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Indeed, the risk of perforation is a major issue and occurs in 7 – 39 % of cases 6 20 21 . Conversely, other authors 19 22 23 reported a 0 – 2.8 % perforation rate by using the EMR technique, concluding that this approach is safe even in large spreading lesions 24 . Recently, underwater EMR has been also described as a successful technique in small adenomas with an en-bloc resection rate of 87 % 25 .…”

Section: Discussionmentioning

confidence: 92%

Comparative analysis of ESD versus EMR in a large European series of non-ampullary superficial duodenal tumors

Pérez-Cuadrado-Robles

Quénéhervé²,

Margos

et al. 2018

Endosc Int Open

View full text Add to dashboard Cite

Background and study aims The choice of endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) in non-ampullary superficial duodenal tumors (NASDTs) is challenging and the benefits of ESD remain unclear. The aim was to comparatively analyze the feasibility, outcomes and safety of these techniques in these lesions. Patients and methods This is an observational and retrospective study. All consecutive patients presenting with NASDTs who underwent EMR or ESD between 2005 and 2017 were included. The following main outcomes were comparatively evaluated: en-bloc and complete (R0) resection rates, and local recurrence. Secondary outcomes were perforation and delayed bleeding. Results One hundred sixty-six tumors in 150 patients (age: 66 years, range: 31 – 83, 42.7 % males) were resected by ESD (n = 37) or EMR (n = 129) and included. The median procedure time (81 vs. 50 min, P = 0.007) and tumor size (25 vs. 20 mm, P = 0.01) were higher in the ESD group. The global malignancy rate was 50.3 %. There were no differences in en-bloc resection (29.7 % vs. 44.2 %, P = 0.115), complete resection (19.4 % vs. 35.5 %, P = 0.069), and local recurrence (14.7 % vs. 16.7 %, P = 0.788) rates. Tumor size was associated with recurrence (28 vs. 20 mm, P = 0.008), with a median follow-up of 6.5 months. Focal recurrence (n = 22, 13.3 %) was treated endoscopically in 86.4 %. En-bloc resection in the ESD group was comparable in large ( ≥ 20 mm) and small lesions (27.6 % vs. 37.5 %, P = 0.587), while this outcome decreased significantly in large lesions resected by EMR (17.4 % vs. 75 %, P < 0.001). Nine perforations were confirmed in 6 lesions (16.2 %) resected by ESD and 3 (2.3 %) by EMR ( P = 0.001). Endoscopic therapy was successful in all but 1 patient (88.9 %) presenting with a delayed perforation. Conclusions ESD may be an alternative to EMR and surgery in selected NASDTs, such as large duodenal tumors where EMR achieves low en-bloc resection rates and the local recurrence may be higher. However, this technique may have a higher risk of perforations.

show abstract

Section: Discussionmentioning

confidence: 92%

Comparative analysis of ESD versus EMR in a large European series of non-ampullary superficial duodenal tumors

Pérez-Cuadrado-Robles

Quénéhervé²,

Margos

et al. 2018

Endosc Int Open

View full text Add to dashboard Cite

show abstract

“…EMR of duodenal adenomas has been shown to be effective in several studies over the past decade [5][6][7][8][9][10][15][16][17]. Substantial complication rates have been described especially after resection of large and giant lesions.…”

Section: Discussionmentioning

confidence: 99%

“…Published studies mostly describe retrospective series with long inclusion periods [8][9][10]. Several attempts have been made to reduce the rate of delayed complications, including clipping or coagulation of visible vessels, various techniques for closure of the resection site, and stenting of the pancreatic duct.…”

Section: Introductionmentioning

confidence: 99%

Complication risk despite preventive endoscopic measures in patients undergoing endoscopic mucosal resection of large duodenal adenomas

et al. 2020

View full text Add to dashboard Cite

Background Endoscopic mucosal resection (EMR) is the standard treatment of ampullary and nonampullary duodenal adenomas. EMR of large (10–29 mm) and giant (≥ 30 mm) lesions carries a risk of complications such as delayed bleeding and perforation. Prospective data on duodenal EMR are scarce. This study aimed to evaluate the efficacy of endoscopic procedures (clipping and coagulation of visible vessels) to prevent complications after EMR of large and giant lesions. Methods 110 patients with 118 adenomas (29 ampullary and 89 nonampullary) were included prospectively. Results 15 lesions were small (12.7 %), 68 were large (57.6 %), and 35 were giant (29.7 %). Endoscopic prevention of delayed complications was performed in 81.4 % (n = 96) of all lesions and 94.3 % (n = 33) of giant lesions. Complete resection was achieved in 111 lesions (94.1 %). Complications were 22 delayed bleedings (18.6 %), 3 intraprocedural perforations (2.5 %), 2 delayed perforations (1.7 %), and 1 stricture (0.8 %). Major complications were associated with lesions size ≥ 30 mm (28.6 % vs. 9.6 %; P = 0.02) and ampullary adenomas (27.6 % vs. 11.2 %; P = 0.07). All minor bleeding and 75 % of major bleeding episodes were treated endoscopically; 25 % of major bleedings needed radiologic embolization. Two fatal courses were observed when delayed perforation occurred after EMR of giant lesions. Residual adenoma was detected in 20.4 % at first follow-up. Conclusions EMR of giant duodenal neoplasia carries a substantial risk of major complications and recurrences. Resection technique and prevention of delayed complications need to be improved. Further measures should be evaluated in randomized studies.

show abstract

“…Although non‐ampullary duodenal epithelial tumors (NADETs) are relatively rare, the incidence of such tumors has been increasing 1,2. While the efficacy of endoscopic resection (ER), such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), has been reported for NADETs,3,4,5,6 ER for NADETs is considered to be difficult, and it is associated with a high incidence of adverse events, such as bleeding and perforation, due to anatomical reasons 7,8,9,10. In addition, fibrosis occurs easily after endoscopic biopsy, which makes subsequent ER difficult 11,12.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic algorithm of magnifying endoscopy with crystal violet staining for non‐ampullary duodenal epithelial tumors

Toya

Endo

Oizumi

et al. 2020

Digestive Endoscopy

View full text Add to dashboard Cite

Objectives Little is known about the usefulness of magnifying endoscopy with crystal violet staining (ME‐CV) for the diagnosis of duodenal tumors. We assessed the ability of ME‐CV to distinguish Vienna classification (VCL) category 4/5 (C4/5) from category 3 (C3) non‐ampullary duodenal epithelial tumors (NADETs). Methods A total of 76 NADETs were studied. We retrospectively analyzed the diagnostic values of the white light endoscopy (WLE) scoring system and the ME‐CV algorithm with receiver operating characteristic (ROC) curves, and three endoscopists calculated the sensitivity, specificity, accuracy, and the area under the curve (AUC) of each. The diagnostic values were tested among NADETs overall and among subgroups of tumors with gastric, gastrointestinal or intestinal mucin phenotypes. Inter‐observer agreement of the diagnostic results was also calculated. Results According to the VCL, 54 lesions (71.1%) were regarded as C3 and 22 lesions (28.9%) as C4/5. The sensitivity, specificity, accuracy and AUC of ME‐CV were higher than those of the WLE scoring system (63.6 vs 54.5, 85.2 vs 75.9, 78.9 vs 69.7, 0.744 vs 0.652, respectively). Inter‐observer agreements of the WLE scoring system and ME‐CV were both moderate (kappa 0.45 and 0.41). ME‐CV had higher sensitivity, specificity, accuracy and AUC than those of the WLE scoring system among the gastric and intestinal phenotypes of NADETs. Conclusions ME‐CV is appropriate for the diagnosis of C4/5 and C3 NADETs.

show abstract

Clinical outcome of EMR of sporadic, nonampullary, duodenal adenomas: a 10-year retrospective

Cited by 58 publications

References 21 publications

Comparative analysis of ESD versus EMR in a large European series of non-ampullary superficial duodenal tumors

Comparative analysis of ESD versus EMR in a large European series of non-ampullary superficial duodenal tumors

Complication risk despite preventive endoscopic measures in patients undergoing endoscopic mucosal resection of large duodenal adenomas

Diagnostic algorithm of magnifying endoscopy with crystal violet staining for non‐ampullary duodenal epithelial tumors

Contact Info

Product

Resources

About