Endoscopic mucosal resection of non-ampullary sporadic duodenal adenomas: a retrospective analysis with long-term follow-up

Valerii, Giorgio; Tringali, Andrea; Landi, Rosario; Boškoski, Ivo; Familiari, Pietro; Bizzotto, Alessandra; Perri, Vincenzo; Petruzziello, Lucio; Costamagna, Guido

doi:10.1080/00365521.2018.1438508

Cited by 25 publications

(36 citation statements)

References 31 publications

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“…However, previous studies showed that incomplete resection including piecemeal resection was not associated with long-term recurrence in SNDA Indeed, one-third of patients underwent piecemeal EMR in the present study; however, no recurrence was observed during follow-up. In a study reporting 75 SNDA treated with EMR, residual and recurrence rate was 14.5 and 10.9%, respectively, during median 59 months of follow-up period [27]. However, all but one was successfully treated endoscopically that showed favorable long term outcome.…”

Section: Discussionmentioning

confidence: 98%

Clinical Outcomes following Endoscopic Treatment for Sporadic Nonampullary Duodenal Adenoma

Na¹,

Kim²,

Ahn³

et al. 2020

Dig Dis

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Background and Aims: Endoscopic treatment for duodenal neoplasms is associated with a high risk of perforation. This study aimed to determine the feasibility of endoscopic treatment for sporadic nonampullary duodenal adenoma (SNDA). Methods: Consecutive patients undergoing endoscopic treatment for SNDA between January 2005 and December 2015 were included in the study. Clinical characteristics and endoscopic outcomes were analyzed using medical records. Long-term outcome was assessed in patients whose followup period was > 12 months > 1 year. Results: A total of 95 lesions (92 patients) were treated with argon plasma coagulation (APC) ablation (n = 25), endoscopic mucosal resection (EMR, n = 59), or endoscopic submucosal dissection (ESD, n = 11). The median age was 54.9 years, and 63% were male. In patients who underwent EMR and ESD, the en bloc resection rate was 83.1 and 90.0% (p > 0.99); and the complete resection rate was 81.4 and 80% (p > 0.99), respectively. Perforation occurred in 8 patients (8.7%), 4 of whom required surgery. The ESD group showed a significantly higher perforation rate than APC or EMR group (45.5 vs. 0 and 5.1%; p < 0.001). During the median follow-up period of 19 months (range 12-137 months), one patient in the APC ablation group experienced recurrence; no recurrences were seen among EMR and ESD groups. Conclusions: Favorable longterm outcomes indicate that endoscopic treatment is an effective approach for the treatment of SNDA. Considering the high risk of perforation associated with ESD, APC, or EMR may be an acceptable alternative.

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Section: Discussionmentioning

confidence: 98%

Clinical Outcomes following Endoscopic Treatment for Sporadic Nonampullary Duodenal Adenoma

Na¹,

Kim²,

Ahn³

et al. 2020

Dig Dis

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“…The final diagnosis of NADLs after ER could be different from the pre-ER forceps biopsy results. [ 24 ] Therefore, though no adenoma is observed in the pre-ER biopsy, once endoscopic findings show an adenomatous polyp, it is necessary to perform ER. Indeed, previous studies have indicated that some endoscopists think pre-resection biopsy was not important and prefer not to perform forceps biopsy before ER in NADL since forceps biopsy can cause fibrosis around the lesion and the result after ER can be higher by up to 40%; a pre-ER biopsy is unreliable.…”

Section: Discussionmentioning

confidence: 99%

Low recurrence rate after endoscopic resection in non-ampullary duodenal lesions

Oh¹,

Je²,

Jung³

et al. 2021

Medicine

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Endoscopic resection (ER) for non-ampullary duodenal lesions (NADLs) is technically more difficult than lesions of the stomach. However, endoscopic treatment of duodenal lesions has been increasingly performed in recent years. This study aimed to evaluate the efficacy and safety of ER for NADLs. Patients who underwent ER for NADLs between 2004 and 2019 were retrospectively reviewed. Clinical and pathologic features of the lesions including the clinical outcomes and adverse events were analyzed. The study included 80 patients with NADLs. The mean age of patients was 59.3 years (22–80 years), the mean size of the lesion was 8.8 ± 7.0 mm, and the mean procedure time was 13.2 ± 11.2 min. Half (40/80) of the lesions were in the duodenal bulb including the superior duodenal angle. Final histological data showed 56 adenomas (70.5%), 13 Brunner gland tumors (16.2%), and 4 pyloric gland tumors (5.0%). The final diagnoses of 5 lesions after ER showed higher-grade dysplasia compared to pre-ER biopsy findings. The en bloc resection rate was 93.8% (75/80), and the complete resection rate with clear margins was 90.0% (72/80). Micro-perforation occurred in 2 of 80 patients and was successfully treated with conservative treatment. There were no cases of delayed bleeding. The mean follow-up period was 27.0 months (2–119 months) with no cases of recurrence. ER may be an effective treatment for NADLs with favorable long-term outcomes. However, the possibility of perforation complications should always be considered during ER.

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“…Our data showed that AEs occurred only during the ESD procedure. Recently, several studies have shown the clinical outcomes of ER of NADETs 19 20 21 27 . These reports showed that EMR is more suitable and safer than ESD, especially for small lesions.…”

Section: Discussionmentioning

confidence: 99%

“…Those reports have shown that NADETs of the gastric phenotype have a higher malignant potential than those of the intestinal type. Recently, several groups of investigators reported on long-term outcomes of ER of NADETs 19 20 21 22 . However, the association between clinical outcomes of ER and mucin phenotypes has not been elucidated in detail.…”

Section: Introductionmentioning

confidence: 99%

The mucin phenotype does not affect the endoscopic resection outcome of non-ampullary duodenal epithelial tumors

et al. 2021

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Background and study aims Some studies have reported an association between clinicopathological features and mucin phenotypes of non-ampullary duodenal epithelial tumors (NADETs). However, the association between clinical outcomes of endoscopic resection (ER) and mucin phenotypes has not been elucidated. The aim of this retrospective study was to analyze clinical outcomes of ER of NADETs with reference to mucin phenotypes. Patients and methods We retrospectively evaluated the clinical outcomes of ER for NADETs performed from 2006 to 2019 and compared clinicopathological characteristics, ER procedures, and outcomes, including adverse events (AEs) among tumors classified by mucin phenotype. Mucin phenotypes were classified as gastric, gastrointestinal, and intestinal based on immunohistochemical examination. Grade of dysplasia was determined according to the Vienna classification (VCL). Results The proportion of VCL 4/5 was higher in the gastric type (50 %) compared with that in the gastrointestinal (39.1 %, P = 0.009) and intestinal types (5.4 %, P = 0.008), respectively. With no statistical difference in tumor size and ER method among the three groups, no significant difference was observed for ER outcomes, i. e., en bloc and R0 resection rates. In the gastrointestinal and intestinal types, AEs occurred in four cases treated with ESD, but none developed in the gastric type. Conclusions This study suggests that the mucin phenotype does not affect resection outcome. However, considering high malignant potential and tendency for low AE rates, the gastric type NADETs may be more appropriate for proactive ER than the others.

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Endoscopic mucosal resection of non-ampullary sporadic duodenal adenomas: a retrospective analysis with long-term follow-up

Abstract: EMR for NASDA is effective with a favorable long-term outcome. Local recurrences can be retreated endoscopically. A recall system, patient's compliance to endoscopic follow-up are mandatory to detect recurrences and their prompt treatment.

Cited by 25 publications

References 31 publications

Clinical Outcomes following Endoscopic Treatment for Sporadic Nonampullary Duodenal Adenoma

Clinical Outcomes following Endoscopic Treatment for Sporadic Nonampullary Duodenal Adenoma

Low recurrence rate after endoscopic resection in non-ampullary duodenal lesions

The mucin phenotype does not affect the endoscopic resection outcome of non-ampullary duodenal epithelial tumors

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