Background and Aims

Sporadic non-ampullary duodenal adenomas (SNADAs), although uncommon, pose clinical challenges. Because SNADAs have malignant potential, endoscopic or surgical resection is generally recommended. EMR is increasingly used for resection of SNADAs, but large-scale data on natural history after EMR are scarce. In this study, we aimed to evaluate the clinical outcome of EMR for SNADAs and the natural history after EMR from a large, single-operator experience with dedicated follow-up.

Methods

We performed a retrospective review of patients with SNADAs who were referred for endoscopic therapy from May 2007 to May 2016. Patient demographics, lesion characteristics, and procedural technical data were collected. The outcomes studied were complete endoscopic resection, major adverse events, and recurrence.

Results

A total of 162 patients were referred for endoscopic therapy, and 142 (88%) (median age 67 years, interquartile range [IQR] 57-73 years, 42% male) underwent a total of 166 EMRs with the use of a submucosal injection and thermal snare resection technique. In per-patient analysis, the median size of SNADAs was 20 mm (IQR 15-30) in diameter. Complete mucosal resection was achieved in 130 of 142 patients (92%). Local or residual recurrences were observed in 23% of patients (median time until recurrence 277 days [IQR 196-591]) and were treated endoscopically. No metachronous recurrences were found within a median follow-up of 363 days. In per-procedure analysis, en bloc resection was achieved in 88 (53%). EMR-related bleeding occurred in 18 (11%) EMRs, and all cases were successfully managed with supportive and/or endoscopic measures. No perforations occurred. Increasing size of adenomas was associated with recurrence (P < .001). No association with recurrence was noted with endoscopic or histologic features. Increasing size of resected specimens (P < .001) was associated with an increased risk of bleeding.

Conclusion

EMR of most SNADAs can be performed safely and effectively. Increasing size of adenomas was associated with recurrence and bleeding after EMR. No association with recurrence was noted with endoscopic or histologic features. Focal recurrence can be managed with additional endoscopic therapy. Metachronous lesions do not occur. The findings inform directed management and surveillance.

中文翻译：

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散发性，非壶腹性，十二指肠腺瘤的EMR临床结果：十年回顾

背景和目标

偶发性非壶腹十二指肠腺瘤（SNADAs）虽然不常见，但却带来了临床挑战。由于SNADA具有恶性潜能，因此通常建议内镜或手术切除。EMR越来越多地用于SNADA的切除，但是EMR之后自然历史的大规模数据却很少。在这项研究中，我们旨在通过大量的单操作者经验和专门的随访评估SNADA的EMR的临床结局和EMR后的自然病史。

方法

我们对2007年5月至2016年5月接受内镜治疗的SNADA患者进行了回顾性研究。收集了患者的人口统计学资料，病变特征和手术技术数据。研究的结果为完全内窥镜切除，主要不良事件和复发。

结果

共有162例患者接受了内镜治疗，其中142例（中位年龄67岁，四分位间距[IQR] 57-73岁，男性42％）通过粘膜下注射接受了166例EMR和热圈套切除术。在每位患者的分析中，SNADA的中位直径为20毫米（IQR 15-30）。142名患者中的130名（92％）完成了完整的粘膜切除术。在23％的患者中观察到局部或残留复发（直到复发277天的中位时间[IQR 196-591]），并进行了内镜治疗。在363天的中位随访中未发现异时复发。在每个过程分析中，有88例（53％）实现了整体切除。18例（11％）EMR中发生了与EMR相关的出血，所有病例均通过支持和/或内窥镜检查得以成功治疗。没有穿孔发生。腺瘤增大与复发相关（P  <.001）。内镜或组织学特征均未发现与复发相关。切除标本的大小增加（P  <.001）与出血风险增加相关。

结论

大多数SNADA的EMR均可安全有效地执行。腺瘤增大与EMR术后复发和出血有关。内镜或组织学特征均未发现与复发相关。局灶性复发可通过其他内镜治疗来控制。不会发生异时性病变。调查结果有助于定向管理和监督。