EMR of large and giant lateral spreading lesions of the duodenum

Kelin_headshotPost written by Amir Klein, MD, from the Endoscopy Unit, Westmead Hospital, in Westmead, New South Wales, Australia

This study investigates the short and long term outcomes of endoscopic mucosal resection (EMR) of large duodenal adenomas.

Large sporadic duodenal adenomas are uncommon, but harbor a malignant potential, which requires consideration of definitive treatment. EMR may be an effective and safe alternative to high-risk surgical procedures, but data on long-term outcomes is limited. We analyzed prospectively collected data from 106 duodenal adenomas ≥10 mm (mean patient age 69 years, 54% male, median lesion size 25mm [IQR 19-40]). Complete endoscopic resection was achieved in 96% and >90% of patients were adenoma free and considered cured during long term follow-up (median follow up 36months IQR [24-51]).

Lesion size was strongly associated with adverse events, particularly bleeding and surveillance is mandatory as small recurrences which are readily amendable to endoscopic treatment are not uncommon. These results demonstrated that in a tertiary referral center, endoscopic resection of duodenal adenomas is a safe and effective alternative to surgery.

emr_rastogi_fig

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).

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