Safety and efficacy of the endoscopic resection of large nonampullary duodenal adenomas / 中华消化内镜杂志

ABSTRACT

Objective To evaluate the safety and efficacy of the endoscopic resection of large nonampullary duodenal adenomas.Methods Twenty cases with large nonampullary duodenal adenomas(≥ 1.0 cm) were referred for EMR.After submucosal injection of the mixture of glycerin fructose solution and methylene blue,either en bloc or piecemeal snare polypectomy was performed.All resected specimens were retrieved for pathologic study.Follow-up gastroscopy was performed in patients after EMR.Results Among 20 lesions,six were found located in the 1st part(30％),13 were in the 2nd part(65％),and one in the 3rd part(5％)of the duodenum.The mean diameter of the lesions was 1.9 ± 1.1 cm.Endoscopic ultrasonography (EUS) was performed in 12 patients,and all lesions were originated from the mucosa.EMR was performed successfully in 20 patients.The en bloc resection rate was 75％ (15/20),and the mean time for EMR was 33.8 ± 16.7 min.The perioperative complication rate was 20％ (4/20).Bleeding occurred within 24 hours after EMR in 4 cases.There were no perforations.The complete resection rate was 100％.Of these 20 adenomas,14 adenomas were tubulous and 6 was tubulovillous.During the follow-up period (2-39 months),1 patient showed recurrence within 6 months after EMR.Conclusion Endoscopic resection of large nonampullary duodenal adenomas is safe and effective treatment.