Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea.
Dig Dis Sci. 2013 Oct;58(10):2926-32. doi: 10.1007/s10620-013-2708-8. Epub 2013 May 22.
Nonampullary sporadic duodenal adenomas (NSDAs) are uncommon mucosal neoplasms with malignant potential. Recently, endoscopic treatment is used for NSDA with increasing frequency.
This study therefore aimed to evaluate the efficacy and safety of endoscopic treatment for NSDA.
A total of 36 NSDAs in 35 consecutive patients were endoscopically eradicated at Samsung Medical Center between October 1994 and May 2011. Data on patient demographics, tumor characteristics, and endoscopic treatment outcomes were obtained and retrospectively analyzed.
Of all patients, 19 (52.8 %) were male. The mean age was 56.0 ± 12.2 (SD) years. Of the 36 NSDAs, 23 lesions were removed by endoscopic resection (ER) including endoscopic mucosal resection (EMR, n = 20) and snare polypectomy (n = 3). In the 23 cases treated with ER, en bloc resection was achieved in 20 (87.0 %). All cases undergoing en bloc resection showed tumor-free resection margins. Thirteen lesions were ablated by argon plasma coagulation (APC). During EMR, bleeding occurred in two cases and perforation occurred in one case. One patient bled during APC. All complications were successfully managed with endoscopic treatment without surgical intervention. During a median follow-up period of 11.4 months (range, 1.8-182.4 months), local recurrence occurred in one patient treated with APC (1/10, 10.0 %). Among patients undergoing ER, no local recurrence occurred but one patient treated with EMR experienced metachronous recurrence.
Endoscopic treatment, including EMR, snare polypectomy, and APC, was an effective and safe treatment for NSDA. Further multi-center large prospective studies are warranted to establish appropriate treatment guidelines for NSDA.
非壶腹散发性十二指肠腺瘤（NSDA）是一种罕见的具有恶性潜能的黏膜肿瘤。最近，内镜治疗越来越多地用于治疗 NSDA。
本研究旨在评估内镜治疗 NSDA 的疗效和安全性。
1994 年 10 月至 2011 年 5 月，三星医疗中心对 35 例连续患者的 36 个 NSDAs 进行了内镜下切除。收集患者的人口统计学、肿瘤特征和内镜治疗结果等数据，并进行回顾性分析。
所有患者中，男性 19 例（52.8%），平均年龄 56.0±12.2（SD）岁。36 个 NSDAs 中，23 个病变通过内镜切除（ER）包括内镜黏膜切除术（EMR，n=20）和圈套息肉切除术（n=3）。在 23 例接受 ER 治疗的病例中，20 例（87.0%）达到整块切除。所有整块切除的病例均显示肿瘤无残留的切缘。13 个病变采用氩等离子凝固术（APC）消融。EMR 过程中出现 2 例出血，1 例穿孔。1 例患者在 APC 过程中出血。所有并发症均通过内镜治疗成功处理，无需手术干预。在中位随访 11.4 个月（范围 1.8-182.4 个月）期间，1 例接受 APC 治疗的患者（1/10，10.0%）出现局部复发。接受 ER 治疗的患者中无局部复发，但 1 例接受 EMR 治疗的患者出现了异时性复发。
内镜治疗，包括 EMR、圈套息肉切除术和 APC，是治疗 NSDA 的有效且安全的方法。需要进一步开展多中心大样本前瞻性研究，为 NSDA 制定合适的治疗指南。
