Safety and efficacy of cap-assisted EMR for sporadic nonampullary duodenal adenomas

Jamil_headshotPost written by Laith H. Jamil, MD, from the Cedars Sinai Medical Center, Los Angeles, California.

The focus of the study was to assess the efficacy and safety of using a transparent hard straight plastic cap with an outer diameter of 13.9 or 14.9 mm and a crescent-shaped snare for endoscopic removal of sporadic non-ampullary duodenal adenomas (SNADAs) using the lift, suction, and cut technique.

Removing duodenal adenomas via endoscopic mucosal resection was traditionally felt to be high risk given the vascularity and thinness of the duodenal wall. In addition, there is relatively high risk of malignant transformation. Often patients are referred to surgery instead of endosopic resection. We had previously published our experience using this technique for colonic polyps and felt it was safe and effective for duodenal adenomas; thus, we wanted to publish our results.

Jamil_fig1

We removed 49 SNADAs, 46 of which were flat adenomas, with an initial eradication rate of 90% (either en bloc resection or negative pathology on follow-up) and a 100% ultimate eradication rate without any recurrence at a median follow-up of 17 months. Pathology showed 16.3% of polyps with high-grade dysplasia. Main adverse events were delayed bleeding (5.1%) and perforation (1.7%).

We would recommend that endoscopists who want to perform this method of endoscopic resection first learn it on esophageal, gastric, rectal, and left-sided colon polyps before attempting it in the duodenum.

Jamil_fig2

Figure 1. A, A flat duodenal polyp. B, Transparent cap with the snare looped in the gutter is positioned at the edge of the polyp. C, Postpolypectomy mucosal defect with no gross residual adenomatous tissue. D, Follow up endoscopy with no evidence of residual adenoma.

Find the article abstract 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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