Introduction Current literature estimates that complete endoscopic resection (ER) of duodenal adenomas can be achieved in 79–100% of cases, but complication rates are high and adenoma recurrence is encountered in up to 37% of cases (Basford & Bhandari, 2012). We present our retrospective experience.
Methods Data from the electronic patient record was analysed for all patients who underwent duodenal polyp resection from June 2013 were included (excl. familial polyposis cases). Procedures were performed by either one of two endoscopists with experience in endoscopic resection. Accepted definitions of technical success, major adverse events and recurrence were used.
Results 31 patients (15F; mean age 67.9± 10.4 y) were included. The mean polyp size was 38.8±23.6 mm, with most (n = 26) located within D2. More than half were laterally spreading lesions (n=16). The main method of resection was with piecemeal EMR (n=24), with 5 removed by en-bloc EMR and 2 by ESD. Histology revealed tubular adenoma low grade dysplasia (n = 12), tubulovillous adenoma with low grade dysplasia (n = 11) and neuroendocrine tumour (n = 3). ER was successful in 28/31 cases (90.3%). Mean size in 3 incomplete resections was 93 mm, with 1 patient referred for surgery, 1 repeat ER and 1 did not proceed due to a more pressing medical diagnosis.
3/31 had peri-procedural complications: endoscopically-treated perforation in 2 (6%) and minor bleeding in 1. 2/31 patients (6%) experienced delayed bleeding, with one patient requiring a repeat OGD but no intervention and the other requiring transfusion of packed red blood cells and observation in hospital. There was no procedure related mortality. At time of writing 4 patients had not yet had surveillance OGD and to date 5 patients (20.8%) had recurrence all treated endoscopically.
Conclusion ER of duodenal polyps is feasible and safe. Our single centre experience is on par with what is published in the literature in regards to technical success and adverse events. A prospective analysis would be of value to guide patient selection, optimal treatment and surveillance protocols.
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