Endoscopic resection of duodenal neoplasms: a single-center study

Abstract

Premalignant duodenal lesions such as adenomas are rare. Surgical resection has been the standard approach to the treatment of these lesions. Endoscopic resection of superficial premalignant or malignant lesions of the gastrointestinal tract is used with increasing frequency. This study aimed to evaluate the safety and efficacy of endoscopic resection of duodenal neoplasms. Patients with nonampullary duodenal adenomas or duodenal adenocarcinomas without familial polyposis syndrome between August 2002 and February 2009 were retrospectively analyzed. Data including location and size, technique used for the endoscopic resection, complications, and follow-up evaluation of the lesions were reviewed. The study enrolled 24 patients with duodenal neoplasms. Of these patients, 23 had duodenal adenomas and 1 had an adenocarcinoma confined to the mucosa. The mean age of the patients was 57 years (range, 40-82). In terms of location, 12 lesions (50%, 12/24) were found in the second portion of the duodenum, and 11 (45.8%, 11/24) were found in the first portion. Tubular adenomas were the most common type (17/24, 70.8%). There were four cases of the villotubular type and three of the villous type. Conventional endoscopic mucosal resection (EMR) was performed for 19 patients, EMR with ligation (EMR-L) for 3 patients, and snare polypectomy for 2 patients. Complete resection was achieved for 87.5% (21/24) of the patients, and the recurrence rate was 8.3% (2/24). All the complications were intraprocedural bleeding (n = 7), with no occurrence of perforation or infection. During a median follow-up period of 6 months (range, 3-36 months), recurrence of the duodenal neoplasm was observed in two cases. There was no procedure-related mortality. Endoscopic resection of duodenal neoplasms was safe and effective treatment. During the short-term follow-up evaluation, EMR showed outcomes and complications comparable with prior procedures, including adenocarcinomas confined to the mucosa.