Cold snare EMR for the removal of large duodenal adenomas

Wang, Hunter; Sidhu, Mayenaaz; Gupta, Sunil; Cronin, Oliver; O’Sullivan, Timothy E.; Whitfield, Anthony; Burgess, Nicholas G.; Bourke, Michael J.

doi:10.1016/j.gie.2023.01.040

Cited by 15 publications

(27 citation statements)

References 25 publications

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“…Ablating the margins after EMR is a known effective way to increase local remission rates after piece-meal EMR of colorectal lesions [17]. However, after repeated resections, in both comparative series there were no significant differences between CSP and EMR in local remission rates (73.7% vs 91.4% and 97.5% vs. 100%) [12,15].…”

Section: Accepted Manuscriptmentioning

confidence: 91%

“…In one of two comparative series, the rate of local remission at 1 st control was significantly lower for CSP than EMR (75.6% vs. 97.7%) [12]. However, in this series, the authors used argon plasma coagulation (APC) to ablate the resection margins after EMR.…”

Section: Accepted Manuscriptmentioning

confidence: 92%

“…We did not study CSP immediate bleeding rates; as for colorectal lesions, this is usually self-limited [18,19]. Delayed bleeding prevention by clipping after CSP of large lesions (median above 20mm) was not done, as it was considered unhelpful and with certain risks [10][11][12]. Smaller size lesions (median below 10mm) were clipped after CSP and there was no delayed bleeding [13,14].…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…Another limitation is that clustering of the lesions could not be accounted for as individual patient data was not available for studies including patients with multiple lesions [12,13,15]. Is this the time for cold snare for all NASDA?…”

Section: Accepted Manuscriptmentioning

confidence: 99%

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Cold snare resection for non-ampullary sporadic duodenal adenomas: systematic review and meta-analysis

Ciocirlan,

Opri,

Bilous

et al. 2023

Endosc Int Open

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Purpose. The role of cold snare polypectomy (CSP) in curative resection of non-ampullary sporadic duodenal adenomas (NASDA) is debated. We conducted a systematic review and meta-analysis to investigate the efficacy and safety of CSP of NASDA. Design. Systematic review and meta-analysis. Method. We identified published series of patients with CSP for NASDA by searching Pubmed and Google Scholar which elicited 6 papers (205 lesions). The main outcome was the rate of local remission after repeated CSP, the secondary outcomes were rates of local remission at first control and rates for delayed bleeding and immediate perforations. We computed the weighted summary proportions under the fixed and random effects model. Results. The pooled proportion of local remission after repeated CSP was 88% (95% CI 57% – 100%). The pooled proportion of local remission at first control was 81% (95% CI 55% – 98%), the pooled proportion of delayed bleeding was 1% (95% CI 0%– 4%) and the pooled proportion of immediate perforation was 0% (95% CI 0% – 2%). Conclusion. Our meta-analysis suggests that CSP should be considered as the first line therapy for NASDA.

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Section: Accepted Manuscriptmentioning

confidence: 91%

Section: Accepted Manuscriptmentioning

confidence: 92%

Section: Accepted Manuscriptmentioning

confidence: 99%

Section: Accepted Manuscriptmentioning

confidence: 99%

See 2 more Smart Citations

Cold snare resection for non-ampullary sporadic duodenal adenomas: systematic review and meta-analysis

Ciocirlan,

Opri,

Bilous

et al. 2023

Endosc Int Open

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“…Cold snare EMR involves piecemeal resection, with or without submucosal injection. In a prospective study, outcomes of 50 patients who underwent cold EMR of duodenal adenomas 15 mm or larger were compared to patients who previously underwent cEMR [78]. CS-EMR reduced intra- and postprocedure bleeding but increased risk of immediate perforation and recurrence at first surveillance.…”

Section: Non-ampullary Duodenal Adenomasmentioning

confidence: 99%

Updates in endoscopic management of ampullary and duodenal adenomas

Chadalavada,

Shah

2023

Current Opinion in Gastroenterology

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Purpose of review Adenomas are the most common benign lesions of the gastrointestinal tract. The current review aims to summarize recent literature regarding risk factors, natural history, diagnostic and staging technique, and management strategies for ampullary and nonampullary duodenal adenomas. Recent findings Recent studies identified several possible risks factors for duodenal adenomas (e.g., cholecystectomy, proton pump inhibitor use), although these associations require corroboration. Chromoendoscopy and endocystoscopy may offer accuracy comparable to biopsies in expert hands. Recent publications underscore the reduction in morbidity with endoscopic resection for lesions without signs of malignancy with submucosal invasion. Submucosal injection did not improve safety of endoscopic ampullectomy. Summary Surveillance may be a reasonable strategy for sub-centimeter ampullary adenomas occurring in familial adenomatous polyposis, as they carry a relatively low risk of malignancy. Endoscopic resection is the preferred strategy over surgery in patients without lesions suggestive of invasive malignancy. For nonampullary duodenal adenomas, several endoscopic resection techniques are available, each with their unique advantages and trade-offs. In patients who are not operative candidates but have intraductal extension, endoscopic ablation is an emerging option.

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Endoscopic indicators in patients with familial adenomatous polyposis undergoing duodenal resections – a nationwide Danish cohort study with long-term follow-up

Karstensen,

Wewer,

Bülow

et al. 2024

Familial Cancer

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Background: Familial adenomatous polyposis (FAP) predisposes individuals to duodenal adenomas. This study describes the histopathological features of endoscopic and surgical specimens from the duodenum, as well as genotype-phenotype associations. Methods: All known FAP patients were included from the Danish Polyposis Register. FAP patients were defined as having more than 100 cumulative colorectal adenomas and/or having a known germline pathogenic variant in the APC gene. Endoscopic procedures, histopathology, and genetics were evaluated. Results: Of 500 FAP patients, 70.6% underwent esophagogastroduodenoscopy (EGD) at least once. Of these, 59.2% presented with detectable duodenal adenomas. The most severe morphology was tubular in 62.7% patients, tubulovillous in 25.4%, and villous in 12.0%, while the most severe dysplasia was low-grade in 67.5% patients, high-grade in 25.4%, and 6.7% had adenocarcinoma. In 6.2% of FAP patients, duodenal resection was recommended, including 29% with duodenal adenocarcinoma. The risk of duodenal surgery was 1.31 per 1,000 person-years (median age: 53 years). The predominant reason for surgery was extensive polyposis (67.7%). Of the patients who underwent duodenal resection, a median of six (IQR: 4–8) EGDs were performed within five years prior to surgery, but 67.6% and 83.9% never underwent a duodenal polypectomy or endoscopic mucosa resection, respectively. Of note, seventeen of 500 patients (3.4%) developed duodenal adenocarcinoma, of which 47% were advanced at diagnosis. Genetic evaluations revealed various pathogenic variants in the APC gene, with no strong genotype-phenotype association. Conclusions: The prevalence of duodenal adenomas and cancer in FAP warrants vigilant endoscopic surveillance. Nevertheless, the need for duodenal surgery persists and should together with endoscopic practice be monitored in national registers.

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Cold snare EMR for the removal of large duodenal adenomas

Cited by 15 publications

References 25 publications

Cold snare resection for non-ampullary sporadic duodenal adenomas: systematic review and meta-analysis

Cold snare resection for non-ampullary sporadic duodenal adenomas: systematic review and meta-analysis

Updates in endoscopic management of ampullary and duodenal adenomas

Endoscopic indicators in patients with familial adenomatous polyposis undergoing duodenal resections – a nationwide Danish cohort study with long-term follow-up

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