Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.
Gastrointest Endosc. 2012 Apr;75(4):805-12. doi: 10.1016/j.gie.2011.11.038. Epub 2012 Feb 3.
Giant hemicircumferential and greater nonampullary duodenal adenomas or laterally spreading tumors (LSTs) may be amenable to safe endoscopic resection, but little data exists on outcomes or risk stratification.
We interrogated a prospectively maintained database of all patients who underwent endoscopic resection between January 2008 and November 2010. The resection technique was standardized. Major complications were defined as perforation, bleeding requiring readmission with hemoglobin drop of more than 20 g/L, or other substantial deviations from the usual clinical course. Outcomes were analyzed in 2 groups: giant lesions (>30 mm) and conventional duodenal polyps (<30 mm in diameter). Statistical evaluation was performed by using a χ(2) test.
A total of 50 nonampullary duodenal polyps and LSTs were resected from 46 patients (23 men, mean age 59.4 years, range 35-83 years). Nineteen were giant hemicircumferential and greater LSTs (mean size 40.5 mm, range 30-80 mm), and 31 were less than 30 mm in diameter (mean size 14.5 mm, range 5-25 mm). Intraprocedural bleeding occurred more frequently in giant lesions (57.8% vs 19.3%, P = .005) and was treated with a combination of soft coagulation and endoscopic clips with hemostasis achieved in all cases. Major complications, mostly bleeding related, occurred in 5 patients (26.3%) with giant lesions and 1 patient (3.2%) with a smaller lesion (P = .014). There were no deaths.
Retrospective observational study in a tertiary center.
Endoscopic resection of giant nonampullary duodenal LSTs is a successful treatment. However, it is hazardous and associated with significantly higher complication rates, primarily bleeding, when compared with conventional duodenal polypectomy. Safer and more effective hemostatic tools are required in this high-risk location.
巨大的环周和非壶腹十二指肠腺瘤或侧向扩展肿瘤（LST）可能适合安全的内镜切除，但关于结局或风险分层的数据很少。
我们查询了 2008 年 1 月至 2010 年 11 月期间所有接受内镜切除的患者的前瞻性数据库。切除技术是标准化的。主要并发症定义为穿孔、出血导致血红蛋白下降超过 20g/L 需要再次入院，或其他与常规临床过程显著偏离的情况。在 2 个组中分析结局：巨大病变（>30mm）和常规十二指肠息肉（直径<30mm）。通过使用 χ(2)检验进行统计学评估。
46 例患者（23 例男性，平均年龄 59.4 岁，范围 35-83 岁）共切除 50 个非壶腹十二指肠息肉和 LST。19 个为巨大的环周和更大的 LST（平均大小 40.5mm，范围 30-80mm），31 个小于 30mm 直径（平均大小 14.5mm，范围 5-25mm）。术中出血在巨大病变中更常见（57.8% vs 19.3%，P=.005），并用软凝固和内镜夹联合处理，所有病例均达到止血。5 例（26.3%）巨大病变和 1 例（3.2%）较小病变患者出现主要并发症（主要与出血相关）（P=.014）。无死亡病例。
三级中心的回顾性观察研究。
内镜切除巨大的非壶腹十二指肠 LST 是一种成功的治疗方法。然而，与常规的十二指肠息肉切除术相比，它具有更大的风险，且并发症发生率显著更高，主要是出血。在这个高风险部位需要更安全、更有效的止血工具。
