Valerii Giorgio, Tringali Andrea, Landi Rosario, Boškoski Ivo, Familiari Pietro, Bizzotto Alessandra, Perri Vincenzo, Petruzziello Lucio, Costamagna Guido
a Digestive Endoscopy Unit , Fondazione Policlinico Universitario "A. Gemelli" - Catholic University , Rome , Italy.
b Fondazione Poliambulanza , Brescia , Italy.
Scand J Gastroenterol. 2018 Apr;53(4):490-494. doi: 10.1080/00365521.2018.1438508. Epub 2018 Feb 19.
We investigate the efficiency of endoscopic mucosal resection (EMR) of non-ampullary sporadic duodenal adenomas (NASDA) in a retrospective analysis with long-term follow-up.
Consecutive patients undergoing EMR of NASDA between May 2002 and December 2016 were retrospectively identified from an electronic database. Endoscopic follow-up was scheduled after 3, 6 and 12 months for the first year, then yearly for up to five years.
EMR of 75 NASDA was performed in 68 patients (56% en-bloc, 44% piecemeal). Retroperitoneal perforations occurred in 3/68 (4.4%) patients, were treated by surgical (n = 2) or percutaneous (n = 1) drainage; delayed bleeding was reported in 13/75 (17.3%) resections and was successfully managed by endoscopy (n = 12) or radiologic embolization (n = 1). There was no procedure-related mortality. Follow-up was available in 61/68 patients (89.7%) after a median time of 59 months from resection. Residual and recurrent adenoma were diagnosed in 9 (14.5%) and 6 (10.9%) cases, respectively; all but one were successfully retreated endoscopically.
EMR for NASDA is effective with a favorable long-term outcome. Local recurrences can be retreated endoscopically. A recall system, patient's compliance to endoscopic follow-up are mandatory to detect recurrences and their prompt treatment.
我们通过一项长期随访的回顾性分析，研究非壶腹性散发性十二指肠腺瘤（NASDA）内镜黏膜切除术（EMR）的疗效。
从电子数据库中回顾性确定2002年5月至2016年12月期间接受NASDA的EMR的连续患者。第一年在术后3、6和12个月安排内镜随访，之后每年随访一次，最长随访五年。
68例患者接受了75例NASDA的EMR（整块切除率56%，分片切除率44%）。3/68（4.4%）例患者发生腹膜后穿孔，分别通过手术（n = 2）或经皮（n = 1）引流治疗；13/75（17.3%）例切除术后报告有延迟出血，通过内镜（n = 12）或放射栓塞（n = 1）成功处理。无手术相关死亡。68例患者中有61例（89.7%）在切除术后中位时间59个月后获得随访。分别有9例（14.5%）和6例（10.9%）诊断为残留腺瘤和复发性腺瘤；除1例患者外，其余均成功接受内镜再次治疗。
NASDA的EMR有效，长期预后良好。局部复发可通过内镜再次治疗。必须建立召回系统，患者需配合内镜随访以检测复发情况并及时治疗。
