Post written by Natalie J. Wilson, MD, from the Department of Internal Medicine, University of Minnesota, and Mohammad Bilal, MD, from Advanced Endoscopy, Division of Gastroenterology and Hepatology, Minneapolis Veteran Affairs Medical Center, and University of Minnesota, Minneapolis, Minnesota, USA.

This study focuses on evaluating the efficacy and safety of cold snare EMR (cs-EMR) for nonampullary duodenal adenomas ≥1 cm. Our primary outcomes were technical success and rates of a residual or recurrent adenoma after resection of a duodenal adenoma using cs-EMR.

Data regarding the use of cs-EMR in the colon have increased, but data about the duodenum are limited. This research aimed to fill that gap and provide data on using cs-EMR for removal of duodenal adenomas.

We found that cs-EMR is safe and technically feasible with a technical success rate of 96.9% and an acceptable recurrence rate of 31.5%. The presence of high-grade dysplasia was an independent predictor of recurrence.

This study adds to existing knowledge by demonstrating that cs-EMR may be an effective alternative to conventional EMR with an excellent safety profile. Our research and prior reports also show that recurrence rates of duodenal adenomas are typically higher than that of colonic adenomas, but the majority of recurrences with cold EMR in our study were able to be managed endoscopically.

Future studies should focus on prospective comparisons among cs-EMR, conventional EMR, and underwater EMR techniques for resection of duodenal adenomas.

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