Lépilliez V, Chemaly M, Ponchon T, Napoleon B, Saurin J C
Hépatogastroentérologie, Hôpital Edouard Herriot, Lyon, France.
Endoscopy. 2008 Oct;40(10):806-10. doi: 10.1055/s-2008-1077619. Epub 2008 Sep 30.
Data on endoscopic resection of sporadic duodenal adenoma (SDA) are sparse; we present our results concerning safety and efficacy in a retrospective analysis of saline-assisted endoscopic resection of SDA.
The cases of all patients who underwent endoscopic resection for SDA between May 1998 and May 2006 were analyzed. Endoscopic resection was carried out using standard injection and cut methods. In some patients hemoclips and argon plasma coagulation were used, either for prophylaxis or for the treatment of procedure-related bleeding.
Thirty-six patients with a total of 37 lesions (mean size 19 mm, range 4 - 50 mm) were analyzed. Lesions larger than 20 mm were more frequently resected piecemeal ( P = 0.022). Intraprocedural bleeding occurred in 14 % of cases, without any significant association with lesion size or the resection technique. One fatal perforation occurred. Macroscopically complete resection was achieved in 97 % of cases, as confirmed by at least one negative control endoscopy with biopsies after a mean follow-up of 15 months. Although clipping and argon plasma coagulation were not applied in any systematic way, it was noticeable that in the 20 cases in which they were used for hemostasis or prevention, no delayed bleeding was observed after the procedures. In contrast, bleeding occurred in 22 % of the 23 procedures performed without these additional techniques.
Endoscopic resection is an efficient and acceptably safe technique for treating SDA. Further studies need to assess whether systematic bleeding prophylaxis will reduce the incidence of delayed hemorrhage after endoscopic resection.
关于散发性十二指肠腺瘤（SDA）内镜切除的数据较少；我们通过对SDA盐水辅助内镜切除的回顾性分析，展示了我们在安全性和有效性方面的结果。
分析了1998年5月至2006年5月期间所有因SDA接受内镜切除的患者病例。采用标准注射和切割方法进行内镜切除。在一些患者中，使用了止血夹和氩离子凝固术，用于预防或治疗与手术相关的出血。
分析了36例患者共37个病变（平均大小19mm，范围4 - 50mm）。大于20mm的病变更常采用分块切除（P = 0.022）。术中出血发生率为14%，与病变大小或切除技术无显著相关性。发生了1例致命穿孔。平均随访15个月后，至少一次活检阴性的对照内镜检查证实，97%的病例实现了宏观完全切除。尽管止血夹和氩离子凝固术未以任何系统方式应用，但值得注意的是，在20例使用它们进行止血或预防的病例中，术后未观察到延迟出血。相比之下，在未采用这些额外技术的23例手术中，22%发生了出血。
内镜切除是治疗SDA的一种有效且安全性可接受的技术。需要进一步研究评估系统性出血预防是否会降低内镜切除术后延迟出血的发生率。
