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What is already known on this topic
Endoscopic resection of duodenal lesions is affected by a high risk of complications. In the colon, cold snare endoscopic resection showed comparable efficacy to conventional polypectomy, and a promising safety profile.
What this study adds
In a retrospective cohort of large duodenal adenomas, we showed the safety profile of cold snare endoscopic resection as compared with an historical cohort of hot technique. No serious adverse events occurred with cold snaring, as compared with the hot snare group. Procedural time was also substantially reduced.
How this study might affect research, practice or policy
Implementation of cold snaring may have a substantial effect on the safety of endoscopic resection of non-ampullary duodenal lesions without indirect signs of invasive cancer. The very low incidence of adverse events may also reduce the intensity of care that is routinely needed to remove duodenal lesions.
Message
Conventional endoscopic mucosal resection using electrocoagulation (hot EMR) for large (>20 mm), sporadic non-ampullary duodenal adenomas is associated with a high complication rate. Based on favourable colonic experience with cold EMR/without electrocautery, we performed a retrospective analysis comparing 33 patients treated this way to 101 patients who had hot EMR for their duodenal adenomas. Data were collected from four tertiary centres in two time periods. No serious adverse events (SAEs) occurred in the cold group, there were 17 intraprocedural SAEs (16.8%) and 26 postprocedural SAEs (25.7%) in the hot EMR group. Procedure time was significantly lower for cold EMR (49±25.1 min vs 96.9±56 min, p<0.01). Recurrence seen at first follow-up endoscopy was comparable in both groups (cold EMR: 4/33; 12.1% versus hot EMR: 21/101; 20.8%). This data suggests that cold EMR is a safe and feasible option for the removal of large non-ampullary duodenal adenomas.
In more detail
Large sporadic duodenal adenomas provide an endoscopic challenge to most endoscopists who are reluctant to resect these lesions due to the high risk of complications.1–4 SAEs associated with conventional hot …
Footnotes
AR and AC are joint first authors.
Contributors AR, TR, RM, CH designed the study. AC, SM, RM, CH and TR wrote the manuscript. AC performed statistical analysis. All authors recruited patients, performed endoscopic procedures, participated in the data collection and revised and approved the final manuscript. AR is a guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.
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