Feasibility of endoscopic resection using bipolar snare for nonampullary duodenal tumours in familial adenomatous polyposis patients.

Abstract

The management of duodenal and colorectal tumours is important in patients with familial adenomatous polyposis (FAP). Endoscopic resection (ER) should be carefully performed because the risk of complications during or after (ER) of nonampullary duodenal tumours is higher than that of stomach or colorectal lesions in general. Thus, we evaluated the feasibility of endoscopic resection using bipolar snare (ERB) for nonampullary duodenal tumours in FAP patients. Eleven FAP patients who underwent ERB for nonampullary duodenal tumours at our hospital between October 2013 and December 2016 were retrospectively analysed based on clinicopathological features. ER was generally indicated for endoscopically diagnosed tumours > 20mm, biopsy-confirmed high-grade dysplasia or carcinomas > 10mm, and multiple tumours. Nineteen endoscopic treatments were performed and 134 nonampullary duodenal tumours were resected. The median patient age at initial treatment was 40years (range 20-64), and median size of the largest tumour in each procedure was 16mm (range 9-40). Of the 101 pathologically evaluated lesions, 10 tumours were high-grade tubular adenomas, 87 were low-grade tubular adenomas, 1 was an adenocarcinoma, and 3 were non-neoplastic mucosal polyps. No intraoperative or delayed perforations were observed. Melena was encountered in one patient and managed without emergent endoscopic intervention. ERB for nonampullary duodenal tumours of FAP patients is feasible and effective, even for large lesions with high-grade dysplasia. Long-term outcomes of ERB, including local recurrence and prognosis, should be monitored.