Efficacy and safety of endoscopic mucosal resection of non-ampullary duodenal polyps: a systematic review.

Abstract

Background and aims: Data on the safety and efficacy of endoscopic resection of non-ampullary duodenal polyps are limited. This study evaluated the safety and efficacy of endoscopic mucosal resection (EMR) of sporadic non-ampullary duodenal polyps. Methods: Relevant studies for the meta-analysis were identified through search of PUBMED and EMBASE databases. Studies employing EMR for the management of sporadic duodenal polyps in the non-ampullary region were included. The primary outcome was the surgical intervention rates due to non-curative endoscopic resection (incomplete removal/recurrence necessitating surgery) and/or management of procedural adverse events. Results: A total of 440 patients (485 duodenal polyps) from 14 studies were included. The mean size of the polyps was 13 mm to 35 mm. Surgical intervention due to non-curative EMR and adverse events was required in 2 % (95 % confidence interval [CI] 0 – 4 %). EMR was successfully accomplished in 93 % (95 %CI 89 – 97 %). The overall bleeding rate after EMR was 16 % (95 %CI 10 – 23 %), and the pooled delayed bleeding rate was 5 % (95 %CI 2 – 7 %). The overall incidence of perforation was 1 % (95 %CI 1 – 3 %). Over a median follow-up period of 6 – 72 months, the recurrence rate after EMR was 15 % (95 %CI 7 – 23 %). Six studies (pooled recurrence 20 %, 95 %CI 14 – 27 %) reported on the outcomes of managing recurrent polyps, for which endoscopic removal was successful in 62 % (95 %CI 37 – 87 %). There was no procedure related mortality. Conclusion: EMR appears to be a safe and effective therapeutic option for management of sporadic non-ampullary duodenal polyps. Long-term endoscopic surveillance is required to manage and treat recurrent disease.