Endoscopic mucosal resection of large and giant lateral spreading lesions of the duodenum: success, adverse events, and long-term outcomes

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• 作者：Amir Klein ; MD¹ ; Dhruv Nayyar ; MD¹ ; Farzan F. Bahin ; MBBS (Hons) ; FRACP ; MPhi¹ ; ² ; Zhengyan Qi ; MD¹ ; Eric Lee ; MBBS ; FRACP¹ ; Stephen J. Williams ; MBBS ; FRACP¹ ; Karen Byth¹ ; Michael J. Bourke ; MBBS ; FRACP¹ ; ² ;
• 关键词：APC ; argon plasma coagulation ; ASA ; American Society of Anesthesiology ; DB ; delayed bleeding ; IPB ; intraprocedural bleeding ; IQR ; interquartile range ; LSL-D ; lateral spreading lesions of the duodenum ; PPI ; proton pump inhibitors ; PPP ; pancreatectomy ; pylorus-preserving pancreatectomy ; PPPD ; pylorus and pancreas-preserving duodenectomy ; SDA ; sporadic duodenal adenoma ; SE ; surveillance endoscopy ; SE1 ; first surveillance endoscopy ; STSC ; snare tip soft coagulation
• 刊名：Gastrointestinal Endoscopy
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：84
• 期：4
• 页码：688-696
• 全文大小：1429 K

文摘

Large sporadic duodenal adenomas are uncommon but they harbor malignant potential, which requires consideration of definitive treatment. EMR is gaining acceptance as an effective and safe alternative to high-risk surgical procedures, but data on long-term outcomes are limited. Herein we describe the short- and long-term outcomes of these lesions in a tertiary referral center.

Methods

Prospectively collected data were analyzed to identify risk factors for adverse events and outcomes. Patient demographics, lesion characteristics, and procedural technical data were collected.

Results

From 2007 to 2015, 106 adenomas ≥10 mm were resected (mean patient age, 69 years; 54% male; median size, 25 mm; interquartile range [IQR], 19–40). Complete endoscopic resection was achieved in 96%. Intraprocedural bleeding occurred in 43% of cases and was associated with lesion size (P < .001), number of resected specimens (P = .003), and longer procedures (P = .001). Delayed bleeding occurred in 15% (56% did not require active intervention) and was associated with lesion size (P = .03). Perforation occurred in 3 patients. The 30-day mortality was 0%. Median follow-up was 22 months (IQR, 7–45). Histologically proven adenoma recurrence was identified and treated in 12 of 83 patients (14.4%) on first surveillance endoscopy. For the 53 patients for whom follow-up ≥12 months was available (median follow-up, 36 months; IQR, 24–51), 48 patients (90.6%) were free of adenoma and considered cured.

Conclusions

In a tertiary referral center, endoscopic resection of duodenal adenomas is a safe and effective alternative to surgery. Lesion size is strongly associated with adverse events, particularly intraprocedural bleeding and delayed bleeding. Good long-term outcomes are demonstrated.