Document Detail


EMR of large, sessile, sporadic nonampullary duodenal adenomas: technical aspects and long-term outcome (with videos).
MedLine Citation:
PMID:  18725157     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: EMR is a viable alternative to surgery for removal of large mucosal neoplastic lesions of the entire GI tract. Few studies have, however, been published on the safety, efficacy, and technical aspects of EMR in the duodenum. OBJECTIVE: Our purpose was to evaluate the efficacy and safety of EMR of large (>15 mm) duodenal adenomas. DESIGN: Retrospective evaluation of a defined patient cohort. SETTING: Tertiary academic referral center. PATIENTS: Patients with large (>15 mm) sporadic nonampullary duodenal adenomas managed by a standardized technique who were referred by other specialist endoscopists for endoscopic treatment. METHODS: Five-year data from patients undergoing EMR for large duodenal adenomas were reviewed retrospectively. Immediate and delayed complications were recorded. RESULTS: Twenty-one lesions were removed by EMR in 23 patients (mean age 62.2 years, 13 female, 10 male). The mean size of lesions resected was 27.6 mm (median 20 mm, range 15-60 mm). Post-EMR histologic examination revealed mucosal adenocarcinoma in 1, low-grade tubulovillous adenoma (TVA) in 16, high- or focal high-grade TVA in 3 patients, and 1 with both high-grade TVA and carcinoid. EMR was performed successfully in 18 patients during a single session. Two patients required 2 sessions and 1 required 3 sessions for complete resection. The median follow-up was 13 months (range 4-44 months). During follow-up, 5 patients had minor residual adenomas that were treated successfully with snare resection and/or argon plasma coagulation. One patient had EMR site bleeding. There were no perforations. LIMITATION: Retrospective study. CONCLUSION: EMR for large sporadic nonampullary duodenal adenomas is a safe and effective technique.
Authors:
Sina Alexander; Michael J Bourke; Stephen J Williams; Adam Bailey; Jonard Co
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Publication Detail:
Type:  Evaluation Studies; Journal Article     Date:  2008-08-23
Journal Detail:
Title:  Gastrointestinal endoscopy     Volume:  69     ISSN:  1097-6779     ISO Abbreviation:  Gastrointest. Endosc.     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2008-12-29     Completed Date:  2009-04-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0010505     Medline TA:  Gastrointest Endosc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  66-73     Citation Subset:  IM    
Affiliation:
Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.
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MeSH Terms
Descriptor/Qualifier:
Adenoma / mortality,  pathology,  surgery*
Aged
Cohort Studies
Duodenal Neoplasms / mortality,  pathology,  surgery*
Duodenoscopy / methods*
Female
Follow-Up Studies
Humans
Intestinal Mucosa / pathology,  surgery*
Male
Middle Aged
Neoplasm Invasiveness / pathology*
Neoplasm Staging
Retrospective Studies
Risk Assessment
Survival Rate
Time Factors
Treatment Outcome
Video-Assisted Surgery / methods

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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