Endoscopy 2018; 50(05): 511-517
DOI: 10.1055/s-0043-124765
Innovations and brief communications
© Georg Thieme Verlag KG Stuttgart · New York

Safety of cold snare polypectomy for duodenal adenomas in familial adenomatous polyposis: a prospective exploratory study

Kenta Hamada
1   Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
2   Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
,
Yoji Takeuchi
1   Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Hideki Ishikawa
3   Ishikawa Gastroenterological Medical Clinic, Osaka, Japan
,
Yasumasa Ezoe
3   Ishikawa Gastroenterological Medical Clinic, Osaka, Japan
,
Masamichi Arao
1   Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Sho Suzuki
1   Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Taro Iwatsubo
1   Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Minoru Kato
1   Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Yusuke Tonai
1   Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Satoki Shichijo
1   Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Yasushi Yamasaki
1   Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
2   Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
,
Noriko Matsuura
1   Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Hiroko Nakahira
1   Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Takashi Kanesaka
1   Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Sachiko Yamamoto
1   Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Tomofumi Akasaka
1   Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Noboru Hanaoka
1   Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Koji Higashino
1   Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Noriya Uedo
1   Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Ryu Ishihara
1   Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Hiroyuki Okada
2   Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
,
Hiroyasu Iishi
1   Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
› Author Affiliations
TRIAL REGISTRATION: Single-center, exploratory, prospective trial UMIN000022525at http://www.umin.ac.jp.
Further Information

Publication History

submitted 18 May 2017

accepted after revision 26 November 2017

Publication Date:
19 January 2018 (online)

Abstract

Background Cold snare polypectomy (CSP) to remove multiple duodenal adenomas (MDAs) in patients with familial adenomatous polyposis (FAP) could be an effective and less invasive method than more extensive surgery. The aim of the present study was to determine the safety of this procedure.

Methods This prospective exploratory study included 10 consecutive patients with FAP and MDAs who underwent CSP for as many as 50 duodenal adenomas. The primary outcome was the incidence of severe adverse events.

Results 10 patients were enrolled and underwent 332 CSPs from June 2016 to January 2017. The median procedure time was 33 minutes (range 25 – 53), and the median number of polyps removed during a single session was 35 (range 10 – 50). Most of the removed polyps were ≤ 10 mm. None of the 10 patients experienced a severe adverse event. One patient developed arterial bleeding during the procedure, but it was easily managed using hemoclips.

Conclusions CSP for MDAs in patients with FAP was safe. The long-term efficacy of this procedure should be investigated.

 
  • References

  • 1 Spigelman AD, Williams CB, Talbot IC. et al. Upper gastrointestinal cancer in patients with familial adenomatous polyposis. Lancet 1989; 2: 783-785
  • 2 Basford PJ, Bhandari P. Endoscopic management of nonampullary duodenal polyps. Ther Adv Gastroenterol 2012; 5: 127-138
  • 3 Ruo L, Coit DG, Brennan MF. et al. Long-term follow-up of patients with familial adenomatous polyposis undergoing pancreaticoduodenal surgery. J Gastrointest Surg 2002; 6: 671-675
  • 4 Hamada K, Takeuchi Y, Ishikawa H. et al. Feasibility of cold snare polypectomy for multiple duodenal adenomas in patients with familial adenomatous polyposis: a pilot study. Dig Dis Sci 2016; 61: 2755-2759
  • 5 Fujimoto K, Fujishiro M, Kato M. et al. Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment. Dig Endosc 2014; 26: 1-14
  • 6 Yamasaki Y, Takeuchi Y, Uedo N. et al. Line-assisted complete closure of duodenal mucosal defects after underwater endoscopic mucosal resection. Endoscopy 2017; 49: E37-E38
  • 7 Tonai Y, Takeuchi Y, Akita H. et al. Iatrogenic duodenal perforation during underwater ampullectomy: endoscopic repair using polyglycolic acid sheets. Endoscopy 2016; 48: E97-E98
  • 8 National Cancer Institute, National Institutes of Health. Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. Maryland: NIH publication. 2009, Revised Version 4.03 2010. Available from http://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_5×7.pdf Accessed: 8 December 2017
  • 9 Inoue T, Uedo N, Yamashina T. et al. Delayed perforation: a hazardous complication of endoscopic resection for non-ampullary duodenal neoplasm. Dig Endosc 2014; 26: 220-227
  • 10 Gallagher MC, Phillips RK, Bulow S. Surveillance and management of upper gastrointestinal disease in familial adenomatous polyposis. Fam Cancer 2006; 5: 263-273
  • 11 Lepilliez V, Chemaly M, Ponchon T. et al. Endoscopic resection of sporadic duodenal adenomas: an efficient technique with a substantial risk of delayed bleeding. Endoscopy 2008; 40: 806-810
  • 12 Marques J, Baldaque-Silva F, Pereira P. et al. Endoscopic mucosal resection and endoscopic submucosal dissection in the treatment of sporadic nonampullary duodenal adenomatous polyps. World J Gastrointest Endosc 2015; 25: 720-727
  • 13 Horiuchi A, Nakayama Y, Kajiyama M. et al. Removal of small colorectal polyps in anticoagulated patients: a prospective randomized comparison of cold snare and conventional polypectomy. Gastrointest Endosc 2014; 79: 417-423