Endoscopic predictors of successful endoluminal eradication in sporadic duodenal adenomas and its acute complications

Abstract

Sporadic duodenal adenomas (SDA) are mucosal neoplasms with malignant potential. Endoscopic eradication used both resection and ablation techniques. Optimal predictors, tools, and techniques for endoscopic eradication of SDA have not been determined. To determine endoscopic predictors of successful endoscopic eradication therapy and the acute complication profile of this therapy. This is a retrospective cohort analysis of 36 consecutive patients referred for management of SDA at a tertiary-care center by a single practitioner. Single-site study. This study involved adult patients referred for endoscopic management of SDA. Endoluminal snare resection was individualized and performed with or without submucosal injection in en bloc or piecemeal fashion. Variables including demographics, endoscopic features of the tumors, and eradication techniques applied were measured against outcomes of complete resection and acute bleeding. Among 36 patients, 11 were male and 25 female, with a mean age of 65.3 ± 11.1 years. Of 33 patients who underwent attempted endoscopic resection, complete resection was achieved in 23 cases (69.7%). Statistically significant negative predictors of complete resection were age >70.5 years (P = .0302), application of argon plasma coagulation (P = .046), and increasing luminal circumference involved by tumors (P < .0001), whereas use of submucosal injection (P = .0121), snare cautery (P < .001), and en bloc resection (P < .001) were positively associated with complete eradication. There were no significant predictors of acute bleeding. This is a retrospective analysis of a single operator's experience. The extent of luminal circumference involved by the tumor is the strongest predictor of successful eradication. This predictor can guide management of SDA.