Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center, Rozzano, MI, Italy.
Department of Gastroenterology, Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, UK.
Surg Endosc. 2022 Jul;36(7):5224-5231. doi: 10.1007/s00464-021-08900-5. Epub 2022 Jan 7.
Sporadic non-ampullary duodenal adenomas (SNDAs) are often referred to tertiary centers because of the challenges in endoscopic resection. There is a paucity of data on both technical and clinical outcomes. The aim of our study was to evaluate the efficacy and safety of endoscopic resection for the treatment of SNDA in two western centers.
This is a retrospective study reporting data of a cohort of patients referred for resection of SNDA between 2013 and 2017. Patients with familial adenomatous polyposis or ampullary lesions were excluded from present analysis. Outcomes considered for this study were technical success, adverse events, recurrence and need for surgery.
120 patients (mean age 66 ± 11.9 years, 64male) were enrolled in the study. Mean size of the lesions was 23.3 mm (range 5-80). Fifty-six en-bloc endoscopic mucosal resection (EMR) (46.6%), 41 piecemeal EMR (pEMR) and 23 endoscopic submucosal dissection were performed. Intra-procedural perforation was observed in 4 patients (3.3%). Fourteen post-procedural (11.6%) adverse events were recorded. All post-procedural perforations occurred in lesions > 30 mm. Recurrence was observed in 11 patients (9.5%) during a mean follow-up of 29 months. All recurrences were successfully managed endoscopically. 119 patients were still alive at last follow-up.
Endoscopic resection can be successfully carried out in majority of patients. Size > 30 mm seems to be the predictor of high adverse events risk.
散发性非壶腹十二指肠腺瘤（SNDAs）由于内镜切除的挑战性，常被转诊至三级中心。目前关于其技术和临床结果的数据很少。本研究的目的是评估在两个西方中心，内镜切除治疗 SNDAs 的疗效和安全性。
这是一项回顾性研究，报告了 2013 年至 2017 年间转诊行 SNDAs 切除术的患者队列数据。本分析排除了家族性腺瘤性息肉病或壶腹部病变患者。本研究考虑的结果为技术成功率、不良事件、复发和手术需求。
研究共纳入 120 例患者（平均年龄 66±11.9 岁，64 例男性）。病变平均大小为 23.3mm（范围 5-80）。56 例行整块内镜黏膜切除术（EMR）（46.6%），41 例行分片 EMR（pEMR），23 例行内镜黏膜下剥离术。4 例患者术中出现穿孔（3.3%）。记录到 14 例术后（11.6%）不良事件。所有术后穿孔均发生在直径>30mm 的病变中。平均随访 29 个月后，11 例（9.5%）患者出现复发。所有复发均在内镜下成功治疗。末次随访时，119 例患者仍存活。
大多数患者可成功行内镜切除术。直径>30mm 似乎是不良事件高风险的预测因素。
