Endoscopic management of nonampullary duodenal polyps

Basford, P; Bhandari, Pradeep

doi:10.1177/1756283x11429590

Cited by 60 publications

(34 citation statements)

References 61 publications

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“…Duodenal tumors/polyps encompass a variety of pathologies of which adenoma is most commonly encountered 2. Adenomas in the duodenum follow the adenoma-carcinoma sequence similar to colonic adenomas 3.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of endoscopic mucosal resection of non-ampullary duodenal polyps: a systematic review

Navaneethan¹,

Hasan²,

Lourdusamy³

et al. 2016

Endosc Int Open

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Background and aims: Data on the safety and efficacy of endoscopic resection of non-ampullary duodenal polyps are limited. This study evaluated the safety and efficacy of endoscopic mucosal resection (EMR) of sporadic non-ampullary duodenal polyps. Methods: Relevant studies for the meta-analysis were identified through search of PUBMED and EMBASE databases. Studies employing EMR for the management of sporadic duodenal polyps in the non-ampullary region were included. The primary outcome was the surgical intervention rates due to non-curative endoscopic resection (incomplete removal/recurrence necessitating surgery) and/or management of procedural adverse events. Results: A total of 440 patients (485 duodenal polyps) from 14 studies were included. The mean size of the polyps was 13 mm to 35 mm. Surgical intervention due to non-curative EMR and adverse events was required in 2 % (95 % confidence interval [CI] 0 – 4 %). EMR was successfully accomplished in 93 % (95 %CI 89 – 97 %). The overall bleeding rate after EMR was 16 % (95 %CI 10 – 23 %), and the pooled delayed bleeding rate was 5 % (95 %CI 2 – 7 %). The overall incidence of perforation was 1 % (95 %CI 1 – 3 %). Over a median follow-up period of 6 – 72 months, the recurrence rate after EMR was 15 % (95 %CI 7 – 23 %). Six studies (pooled recurrence 20 %, 95 %CI 14 – 27 %) reported on the outcomes of managing recurrent polyps, for which endoscopic removal was successful in 62 % (95 %CI 37 – 87 %). There was no procedure related mortality. Conclusion: EMR appears to be a safe and effective therapeutic option for management of sporadic non-ampullary duodenal polyps. Long-term endoscopic surveillance is required to manage and treat recurrent disease.

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Section: Introductionmentioning

confidence: 99%

Efficacy and safety of endoscopic mucosal resection of non-ampullary duodenal polyps: a systematic review

Navaneethan¹,

Hasan²,

Lourdusamy³

et al. 2016

Endosc Int Open

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“…Superficial non‐ampullary duodenal tumors (SNADT) can occur sporadically or as part of a polyposis syndrome. Sporadic SNADT, which arise in patients without a known polyposis syndrome, are usually solitary, and the majority of them are sessile or flat rather than pedunculated . With the widespread use of EGD, an increasing number of SNADT are diagnosed .…”

Section: Introductionmentioning

confidence: 99%

Therapeutic outcomes of endoscopic resection for superficial non‐ampullary duodenal tumor

Yamamoto

Yoshizawa

Tomida

et al. 2014

Digestive Endoscopy

108

131

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Background and Aim: Endoscopic resection (ER) is widelyused as a minimally invasive therapy to remove superficial nonampullary duodenal tumor (SNADT). However, the indication criteria have not yet been clearly determined. At our institute, ER is done only for SNADT measuring ≤20 mm. We report our findings on the therapeutic outcomes of ER of SNADT. Methods:We carried out ER in 47 patients with SNADT. Indication criteria for ER included a lesion suspected as high-grade dysplasia or mucosal cancer and measuring ≤20 mm. The ER methods used to carry out en bloc resection were endoscopic mucosal resection (EMR: 17 lesions) or endoscopic submucosal dissection (ESD: 30 lesions). We then analyzed the therapeutic outcomes between them.Results: There were no significant differences between the EMR and ESD groups with regard to age, sex, location of the lesion, and histology. The most frequent gross types resected by EMR and ESD were 0-IIa and 0-IIc, respectively (P = 0.004). Median procedure time was significantly longer in ESD than in EMR, 79.5 and 9 min, respectively (P < 0.001). R0 resection was achieved in 10 cases by EMR (59%) and in 27 cases by ESD (90%) (P = 0.017). No complications occurred in cases that underwent EMR, but immediate and delayed perforations occurred in three patients who underwent ESD, although this difference was not statistically significant (P = 0.467).Conclusion: Using our indication criteria, which limited lesion size to ≤20 mm, satisfactory therapeutic outcomes of ER of SNADT were obtained.

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“…However SDA size is a variable determinant of high grade dysplasia or malignant change with authors quoting a size > 10 mm[30], > 20 mm[8,27,28,31], and > 30 mm[29]. ASGE guidelines suggest the use of EUS in lesions > 2 cm in non-ampullary and > 1 cm in ampullary adenoma[22].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic assessment and management of sporadic duodenal adenomas: The results of single centre multidisciplinary management

Rajkomar

Kweon

Khan

et al. 2017

WJGE

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AIMTo review the role of multidisciplinary management in treating sporadic duodenal adenomas (SDA).METHODSSDA managed at North Shore Hospital between 2009-2014 were entered into a prospective database. Pathology, endoscopic and surgical management as well as follow up were reviewed.RESULTSTwenty-eight patients (14 male: Median age 68 years) presented with SDA [18 were classified as non ampullary location (NA), 10 as ampullary location (A)]. All SDA were diagnosed on upper gastrointestinal endoscopy and were imaged with a contrast enhanced CT scan of the chest, abdomen and pelvis. Of the NA adenomas 14 were located in the second part, 2 in the first part and 2 in the third part of the duodenum. Two patients declined treatment, 3 patients underwent surgical resection (2 transduodenal resections and 1 pancreaticoduodenectomy), and 23 patients were treated with endoscopic mucosal resection (EMR). The only complication with endoscopic resection was mild pancreatitis post procedure. Patients were followed with gastroduodenoscopy for a median of 22 mo (range: 2-69 mo). There were 8 recurrences treated with EMR with one patient proceeding to pancreaticodeuodenectomy because of high grade dysplasia in the resected specimen and 2 NA recurrences were managed with surgical resection (distal gastrectomy for a lesion in the first part of the duodenum and a transduodenal resection of a lesion in the third part of the duodenum).CONCLUSIONSDA can be treated endoscopically with minimal morbidity and piecemeal resection results in eradication in nearly three quarters of patients. Recurrent SDA can be treated with endoscopic reresection with surgical resection indicated when the lesions are large (> 4 cm in diameter) or demonstrate severe dysplasia or invasive cancer.

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Endoscopic management of nonampullary duodenal polyps

Cited by 60 publications

References 61 publications

Efficacy and safety of endoscopic mucosal resection of non-ampullary duodenal polyps: a systematic review

Efficacy and safety of endoscopic mucosal resection of non-ampullary duodenal polyps: a systematic review

Therapeutic outcomes of endoscopic resection for superficial non‐ampullary duodenal tumor

Endoscopic assessment and management of sporadic duodenal adenomas: The results of single centre multidisciplinary management

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