Post written by Mayenaaz Sidhu, MBBS, from the Department of Gastroenterology and Hepatology, Westmead Hospital, and Westmead Clinical School, The University of Sydney, Sydney, Australia.
Endoscopic mucosal resection (EMR) for large (>10-mm), sporadic, non-ampullary duodenal laterally spreading lesions (LSLs) is established as an effective treatment. However, one of the major limitations of EMR is the issue of adenoma recurrence with an estimated frequency between 14% and 26%. A recently published randomized trial evaluated the performance of thermal ablation of the defect margin after EMR (EMR-T) to reduce RRA at 6-month surveillance colonoscopy for large (>20-mm) colorectal LSLs. Therefore, the primary aim of this study was to assess the utility of EMR-T to prevent RRA at first surveillance endoscopy (SE1) in the duodenum.
Endoscopic treatment of RRA in the duodenum is technically challenging and is attended by significant risk due to the presence of submucosal fibrosis within the thin, fixed, richly vascularized duodenal wall. Use of mechanical clipping or thermal treatment to treat recurrence is therefore far more hazardous in the duodenum as compared to the colorectum. In addition, many of these patients require multiple endoscopic procedures to control disease burden, due to RRA, which has significant ramifications on endoscopic and healthcare resources.
Among 49 patients in the EMR-T group that were eligible for SE1, recurrence occurred in 1 (2.3%) patient vs 19 (17.6%) patients who underwent conventional EMR (P = 0.01). No difference in EMR-related adverse events were identified. This study demonstrates another critical advance for minimally invasive resection techniques in the duodenum.
As this study was designed to evaluate a new application of EMR-T, large prospective trials are needed to evaluate the long-term efficacy of this treatment.
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