Long‐term outcomes of cold snare polypectomy for superficial non‐ampullary duodenal epithelial tumors

Abstract

Background and Aim:The effectiveness of cold snare polypectomy (CSP) for superficial non-ampullary duodenal epithelial tumors (SNADETs) regarding long-term outcomes is not fully clarified. This study aimed to investigate long-term outcomes of CSP for SNADETs. Methods: Patients diagnosed with sporadic SNADETs and treated with CSP at Chiba University Hospital between March 2015 and May 2018 were retrospectively analyzed. Long-term outcomes, short-term outcomes, and adverse events were investigated. Results: In total, 35 patients with 46 lesions were included. The en-bloc resection rate was 97.8%. Thirty-seven lesions (80.4%) were diagnosed as adenomatous. The R0 resection rate for adenomatous lesions was 70.3%. Follow-up investigations more than 12 months after CSP were completed for 35 adenomatous lesions (94.6%). The median observation period after CSP was 48 months. One patient whose observation period was only 3 months died from chronic heart failure with cardiac sarcoidosis 6 months after CSP. No patient died from SNADETs. The relapse-free survival rate at 12 months after CSP was 97.1%. One recurrence (2.7%) was observed 12 months after CSP. We removed the recurrence lesion with CSP and cold forceps polypectomy. No new recurrence occurred within the observation period. No perforation or post-operative bleeding occurred for CSP. Conclusions: Cold snare polypectomy for diminutive and small SNADETs is a safe and useful procedure with a high en-bloc resection rate and long-term local control capability.

Issues and Prospects of Current Endoscopic Treatment Strategy for Superficial Non-Ampullary Duodenal Epithelial Tumors

“…Okimoto et al [ 12 ] reported the outcomes of CSP for 47 lesions with a median endoscopic size of 4 mm. The en-bloc and R0 resection rates were 97.8% and 70.3%, respectively.…”

Endoscopic resection of non-ampullary duodenal adenomas: Is cold snaring the promised land?

“…While no long-term follow-up data were available for these above reported studies, Okimoto et al [ 51 ] performed a single center retrospective study to evaluate long-term outcomes of CSP for SNADETs. 29 patients underwent CSP for 37 sporadic duodenal adenomatous lesions; mean size was 4.4 mm[ 51 ]. The en bloc and R0 resection rates were 97.3% and 70.3%, respectively.…”

“…The relapse free survival rate per lesion after 12 mo was 97.1%. Neither delayed bleeding no perforation was reported and no procedure-related death occurred[ 51 ].…”

Cold versus hot EMR for large duodenal adenomas

“…Cold snare EMR (cold EMR) has already been shown to be a safe and viable option for resecting larger polyps in the colon 6. Preliminary small studies evaluating cold EMR in the duodenum have reported recurrence rates of 0%–45% for large adenomas 7–12. These studies have not included direct comparison with hot EMR.…”