Clinical Outcomes following Endoscopic Treatment for Sporadic Nonampullary Duodenal Adenoma

Abstract

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.

Risk Factors of Non-en Bloc Resection and Non-R0 Resection During Endoscopic Resection in the Treatment of Superficial Duodenal Epithelial Lesions

“…The en bloc resection rate was 95.62% (131/137), R0 resection rate was 91.97% (126/137), the positive margin rate of postoperative pathological results was 3.65% (5/137), the postoperative bleeding rate was 2.19% (3/137), and no postoperative perforation to be found. The en-bloc resection rate of EMR in this study (112/114, 98.25%) is slightly higher than those reported in previous study ( 6 , 15 – 20 ), this may be because the lesions size (average size was 1.11 ± 0.60 cm) managed by EMR in our study is relatively small. What’s more, our institution is a high-volume institution that actively carries out endoscopic treatment, which may obtain better curative effect ( 13 , 21 ).…”

Endoscopic management of superficial nonampullary duodenal tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

“…Furthermore, comparative data analysis between EMR and ESD showed better R0 rates for large lesions with ESD but no differences in long-term outcomes and survival [20,61,74,76,82]. However, intraprocedural perforation (up to 30 %) and delayed perforation was significantly associated with ESD [20,61,75,77,83]. Therefore, in most cases, the focus of duodenal endoscopic resection should primarily be on safety, rather than on achieving en bloc or R0 resection.…”

“…In more recent retrospective studies, high rates of complete endoscopic resection (90.5 %-96.1 %) have been obtained with EMR, whereas the adverse event rates ranged from 2 % to 24.4 % [17,19,[53][54][55][56][57][58][59][60][61]. Increasing lesion size was associated with reduced rates of en bloc resection as well as increased rate of adverse events [50,53,[55][56][57]62].…”

“…Nevertheless, more limited duodenal ESD data from Europe are available [20,81,82], and the largest series reported a disappointing en bloc resection rate of 29.7 %, with a 14.7 % recurrence rate [20]. Furthermore, comparative data analysis between EMR and ESD showed better R0 rates for large lesions with ESD but no differences in long-term outcomes and survival [20,61,74,76,82]. However, intraprocedural perforation (up to 30 %) and delayed perforation was significantly associated with ESD [20,61,75,77,83].…”

Computer-assisted and magnetic resonance imaging assessment of tumors and tumor invasion of the duodenum

“…Описаны и спорадические наблюдения [2]. Аденомы чаще локализуются в D2, в 94,7% наблюдений гистологически представлены дисплазией низкой степени, что свидетельствует о низкой степени злокачественности, в 5,3%дисплазией высокой степени [28]. Трансформация аденомы с низкой степенью дисплазии до аденокарциномы может происходить от 15 до 20 лет [29].…”