TY - JOUR
T1 - Outcomes of cold snare EMR of nonampullary duodenal adenomas ≥1 cm
T2 - a multicenter study
AU - Wilson, Natalie
AU - Abdallah, Mohamed
AU - Schulman, Allison R.
AU - Mosko, Jeffrey D.
AU - Saeed, Ahmed
AU - Kothari, Shivangi
AU - Kaul, Vivek
AU - Kothari, Truptesh H.
AU - Phan, Jennifer
AU - Kumar, Anand
AU - Tofani, Christina
AU - Kim, Raymond E.
AU - Westanmo, Anders
AU - Moy, Benjamin M.
AU - Dang, Frances
AU - Canakis, Andrew
AU - Sharma, Neil
AU - Muniraj, Thiruvengadam
AU - Azeem, Nabeel
AU - Bilal, Mohammad
N1 - Publisher Copyright:
© 2024 American Society for Gastrointestinal Endoscopy
PY - 2024/6
Y1 - 2024/6
N2 - Background and Aims: Endoscopic mucosal resection (EMR) with use of electrocautery (conventional EMR) has historically been used to remove large duodenal adenomas; however, use of electrocautery can predispose to adverse events including delayed bleeding and perforation. Cold snare EMR (cs-EMR) has been shown to be safe and effective for removal of colon polyps, but data regarding its use in the duodenum are limited. The aim of this study was to evaluate the efficacy and safety of cs-EMR for nonampullary duodenal adenomas ≥1 cm. Methods: This was a multicenter retrospective study of patients with nonampullary duodenal adenomas ≥1 cm who underwent cs-EMR from October 2014 to May 2023. Patients who received any form of thermal therapy were excluded. Primary outcomes were technical success and rate of recurrent adenoma. Secondary outcomes were adverse events and predictors of recurrence. Results: A total of 125 patients underwent resection of 127 nonampullary duodenal adenomas with cs-EMR. Follow-up data were available in 89 cases (70.1%). The recurrent adenoma rate was 31.5% (n = 28). Adverse events occurred in 3.9% (n = 5), with 4 cases of immediate bleeding (3.1%) and 1 case of delayed bleeding (.8%). There were no cases of perforation. The presence of high-grade dysplasia was found to be an independent predictor of recurrence (odds ratio, 10.9 [95% confidence interval, 1.1-102.1]; P = .036). Conclusions: This retrospective multicenter study demonstrates that cs-EMR for nonampullary duodenal adenomas is safe and technically feasible with an acceptable recurrence rate. Future prospective studies are needed to directly compare outcomes of cs-EMR with conventional and underwater EMR.
AB - Background and Aims: Endoscopic mucosal resection (EMR) with use of electrocautery (conventional EMR) has historically been used to remove large duodenal adenomas; however, use of electrocautery can predispose to adverse events including delayed bleeding and perforation. Cold snare EMR (cs-EMR) has been shown to be safe and effective for removal of colon polyps, but data regarding its use in the duodenum are limited. The aim of this study was to evaluate the efficacy and safety of cs-EMR for nonampullary duodenal adenomas ≥1 cm. Methods: This was a multicenter retrospective study of patients with nonampullary duodenal adenomas ≥1 cm who underwent cs-EMR from October 2014 to May 2023. Patients who received any form of thermal therapy were excluded. Primary outcomes were technical success and rate of recurrent adenoma. Secondary outcomes were adverse events and predictors of recurrence. Results: A total of 125 patients underwent resection of 127 nonampullary duodenal adenomas with cs-EMR. Follow-up data were available in 89 cases (70.1%). The recurrent adenoma rate was 31.5% (n = 28). Adverse events occurred in 3.9% (n = 5), with 4 cases of immediate bleeding (3.1%) and 1 case of delayed bleeding (.8%). There were no cases of perforation. The presence of high-grade dysplasia was found to be an independent predictor of recurrence (odds ratio, 10.9 [95% confidence interval, 1.1-102.1]; P = .036). Conclusions: This retrospective multicenter study demonstrates that cs-EMR for nonampullary duodenal adenomas is safe and technically feasible with an acceptable recurrence rate. Future prospective studies are needed to directly compare outcomes of cs-EMR with conventional and underwater EMR.
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M3 - Article
C2 - 38092125
AN - SCOPUS:85190856185
SN - 0016-5107
VL - 99
SP - 971-980.e1
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 6
ER -