Associate Editor Amit Rastogi, MD, FASGE, highlights this article from the October issue “Endoscopic mucosal resection of large and giant lateral spreading lesions of the duodenum: success, adverse events, and long-term outcomes” by Amir Klein, MD, Dhruv Nayyar, MD, Farzan F. Bahin, MBBS (Hons), FRACP, MPhi, et al. 

This study describes the short and long term outcomes after endoscopic mucosal resection of large sporadic duodenal adenomas.

The success rate for complete endoscopic resection was 96%. Although intraprocedural bleeding was high (43%), delayed bleeding seen in only 15% and lesion size was associated with both. Risk of perforation was low. Recurrence of adenoma was seen in 14% upon surveillance endoscopy. The majority of patients (90%) were adenoma free after 12 month follow up.

This article highlights the overall safety and effectiveness of endoscopic resection of large duodenal adenomas and therefore is an excellent alternative to surgery. Large duodenal adenomas can be safely resected by endoscopist with a high success rate. Lesion size is associated with risk of bleeding.

Read the article abstract here.

Figure 2. EMR of a nearly circumferential 60-mm duodenal adenoma. EMR inject and resect technique was used. The final mucosal defect was covered with Endoclot (Endoclot Plus Inc., Santa Clara, Calif, USA).