Band and slough technique for nonampullary duodenal adenomas

Naresh T. Gunaratnam, MD and Eugene Zolotarevsky, MD from the Department of Gastroenterology, Huron Gastroenterology in Ypsilanti and St. Joseph Mercy Hospital in Ann Arbor, Michigan, USA discusses this Original Article “Efficacy and safety of the band and slough technique for endoscopic therapy of nonampullary duodenal adenomas: a case series.”

Standard endoscopic resection of duodenal adenomas carries a substantial risk of serious adverse events such as bleeding and perforation. We present a series of patients who underwent a novel endoscopic therapy using band and slough (BAS) technique without electrocautery. We were able to eradicate the adenomatous tissue without encountering adverse events.

Duodenal adenomas carry a risk dysplastic progression and cancer and therefore must be removed. We feel that the BAS technique can offer a safe, effective, and technically easier approach then standard endoscopic resection for managing these lesions. The technique utilizes a banding device that is familiar to endoscopists who perform variceal banding and does not require specialized training. With this technique, endoscopists can now easily treat what was previously felt to be challenging duodenal lesions.

Figure 3Figure 3. Complete resolution of an adenoma without recurrence for 24 months after 1 treatment session.

The described BAS technique in a small series of patients proved effective in treating medium sized (1-2 cm) duodenal adenomas both sporadic and familial types. The lesions were carefully interrogated by pretreatment biopsies and endoscopic imaging techniques including narrow band imaging to exclude invasive disease. Treatment was performed by deployment of bands under the polyp tissue allowing the polyp to slough off by ischemic necrosis. Follow up endoscopy was performed to evaluate for residual or recurrent disease. Larger polyps tended to require 2 sessions for complete eradication. On follow up, “touch up” APC treatment or second banding were performed. All patients had documented complete histologic eradication of adenomatous tissue confirmed by submucosal tattoo-directed biopsies with 24 months follow up.  There were no immediate or delayed adverse events such as bleeding or perforations.

These findings are encouraging that this technique can be safely and effectively applied for these very challenging duodenal lesions. Further studies including larger multicenter trials should be performed comparing this technique to standard endoscopic resection techniques.

Read the abstract for this article here.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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