Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, Sydney, New South Wales, Australia.
Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, Sydney, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia.
Gastrointest Endosc. 2016 Oct;84(4):688-96. doi: 10.1016/j.gie.2016.02.049. Epub 2016 Mar 11.
Large sporadic duodenal adenomas are uncommon but they harbor malignant potential, which requires consideration of definitive treatment. EMR is gaining acceptance as an effective and safe alternative to high-risk surgical procedures, but data on long-term outcomes are limited. Herein we describe the short- and long-term outcomes of these lesions in a tertiary referral center.
Prospectively collected data were analyzed to identify risk factors for adverse events and outcomes. Patient demographics, lesion characteristics, and procedural technical data were collected.
From 2007 to 2015, 106 adenomas ≥10 mm were resected (mean patient age, 69 years; 54% male; median size, 25 mm; interquartile range [IQR], 19-40). Complete endoscopic resection was achieved in 96%. Intraprocedural bleeding occurred in 43% of cases and was associated with lesion size (P < .001), number of resected specimens (P = .003), and longer procedures (P = .001). Delayed bleeding occurred in 15% (56% did not require active intervention) and was associated with lesion size (P = .03). Perforation occurred in 3 patients. The 30-day mortality was 0%. Median follow-up was 22 months (IQR, 7-45). Histologically proven adenoma recurrence was identified and treated in 12 of 83 patients (14.4%) on first surveillance endoscopy. For the 53 patients for whom follow-up ≥12 months was available (median follow-up, 36 months; IQR, 24-51), 48 patients (90.6%) were free of adenoma and considered cured.
In a tertiary referral center, endoscopic resection of duodenal adenomas is a safe and effective alternative to surgery. Lesion size is strongly associated with adverse events, particularly intraprocedural bleeding and delayed bleeding. Good long-term outcomes are demonstrated.
大型散发性十二指肠腺瘤并不常见，但具有恶性潜能，需要考虑确定性治疗。EMR 作为一种替代高风险手术的有效且安全的方法正在被接受，但长期结果的数据有限。在此，我们在一家三级转诊中心描述这些病变的短期和长期结果。
对前瞻性收集的数据进行分析，以确定不良事件和结果的危险因素。收集患者人口统计学、病变特征和程序技术数据。
2007 年至 2015 年，106 个≥10mm 的腺瘤被切除（平均患者年龄 69 岁；54%为男性；中位大小 25mm；四分位间距[IQR]19-40）。96%的患者实现了完全内镜下切除。术中出血发生在 43%的病例中，与病变大小（P<.001）、切除标本数量（P=.003）和较长的手术时间（P=.001）有关。迟发性出血发生在 15%（56%不需要积极干预），与病变大小有关（P=.03）。3 例发生穿孔。30 天死亡率为 0%。中位随访时间为 22 个月（IQR 7-45）。83 例患者中的 12 例（14.4%）在首次监测内镜检查中发现并治疗了组织学证实的腺瘤复发。对于 53 例随访时间≥12 个月的患者（中位随访时间 36 个月；IQR 24-51），48 例（90.6%）无腺瘤且被认为治愈。
在三级转诊中心，内镜切除十二指肠腺瘤是手术的一种安全有效的替代方法。病变大小与不良事件密切相关，特别是术中出血和迟发性出血。结果显示长期效果良好。
