Koritala Thoyaja, Zolotarevsky Eugene, Bartley Angela N, Ellis Carla D, Krolikowski Jennifer A, Burton Jill, Gunaratnam Naresh T
Department of Internal Medicine, St. Joseph Mercy Hospital, Ypsilanti, Michigan, USA.
Department of Gastroenterology, Huron Gastroenterology, St. Joseph Mercy Hospital, Ypsilanti, Michigan, USA.
Gastrointest Endosc. 2015 Apr;81(4):985-8. doi: 10.1016/j.gie.2014.09.043. Epub 2014 Nov 22.
Endoscopic resection of nonampullary duodenal adenomas (NADAs) is effective but carries substantial procedural risks. Therapeutic banding for treatment of duodenal mucosal neoplasia has not been studied. We report a novel band and slough (BAS) technique for therapy of NADA without endoscopic resection.
Efficacy and safety of BAS.
Retrospective review of a prospective database.
Community hospital.
Patients with sporadic and familial biopsy-proven NADA without invasive cancer undergoing BAS.
Patients were treated with BAS without endoscopic resection on an outpatient basis. A follow-up telephone call was made by a nurse at 24 hours. Follow-up endoscopy was performed at 8 weeks, with further therapy of residual NADA. In patients with minimal residual NADA not amenable to banding, argon plasma coagulation (APC) "touch-up" was used. Subsequent endoscopic surveillance was performed.
Complete histologic remission of NADA after successful BAS and postprocedure bleeding, perforation, and pain.
Ten patients, average age 65 years, 6 male, with sporadic/familial adenomatous polyposis NADA 8 of 2 (6 tubular adenoma and 4 tubulovillous adenoma) were treated. Mean (largest) NADA was 12.5 mm (20 mm). Five patients achieved complete remission after a single session. Among 5 patients requiring further therapy, 3 were treated with repeat banding with or without APC and 2 with APC alone. The average number of bands per session was 4.4. Patients were followed up to 24 months without NADA recurrence. None of the patients had acute or delayed adverse events of bleeding, perforation, or postprocedure pain.
Lack of polyp tissue retrieval.
BAS appears to be a safe and potentially effective endoscopic treatment for NADA. However, larger studies are needed to corroborate these findings.
内镜下切除非壶腹十二指肠腺瘤（NADA）有效，但存在重大操作风险。十二指肠黏膜肿瘤的治疗性套扎术尚未得到研究。我们报告一种无需内镜切除治疗NADA的新型套扎与脱落（BAS）技术。
BAS的疗效与安全性。
对前瞻性数据库进行回顾性分析。
社区医院。
经活检证实为散发性和家族性NADA且无浸润性癌的患者接受BAS治疗。
患者在门诊接受BAS治疗，无需内镜切除。护士在24小时进行随访电话。8周时进行随访内镜检查，对残留的NADA进行进一步治疗。对于残留极少、无法进行套扎的NADA患者，采用氩等离子体凝固（APC）“补修”。随后进行内镜监测。
成功进行BAS后NADA的组织学完全缓解以及术后出血、穿孔和疼痛情况。
10例患者，平均年龄65岁，男性6例，患有散发性/家族性腺瘤性息肉病性NADA，其中8例为管状腺瘤，2例为绒毛状腺瘤（6例管状腺瘤和4例绒毛管状腺瘤）。平均（最大）NADA为12.5毫米（20毫米）。5例患者单次治疗后实现完全缓解。在5例需要进一步治疗的患者中，3例接受了重复套扎，伴或不伴APC治疗，2例仅接受APC治疗。每次治疗的平均套扎带数量为4.4条。患者随访至24个月，无NADA复发。所有患者均未出现出血、穿孔或术后疼痛等急性或延迟性不良事件。
缺乏息肉组织获取。
BAS似乎是一种安全且可能有效的NADA内镜治疗方法。然而，需要更大规模的研究来证实这些发现。
