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Endoscopy 2020; 52(10): 847-855
DOI: 10.1055/a-1144-2767
Original article

Complication risk despite preventive endoscopic measures in patients undergoing endoscopic mucosal resection of large duodenal adenomas

Andreas Probst
1   Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
,
Simone Freund
1   Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
,
Lukas Neuhaus
1   Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
,
Alanna Ebigbo
1   Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
,
Georg Braun
1   Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
,
Stefan Goelder
1   Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
,
Tobias Weber
1   Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
,
Bruno Märkl
2   Institute of Pathology, University Hospital Augsburg, Augsburg, Germany
,
Matthias Anthuber
3   Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Augsburg, Germany
,
Helmut Messmann
1   Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
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Abstract

Background Endoscopic mucosal resection (EMR) is the standard treatment of ampullary and nonampullary duodenal adenomas. EMR of large (10–29 mm) and giant (≥ 30 mm) lesions carries a risk of complications such as delayed bleeding and perforation. Prospective data on duodenal EMR are scarce. This study aimed to evaluate the efficacy of endoscopic procedures (clipping and coagulation of visible vessels) to prevent complications after EMR of large and giant lesions.

Methods 110 patients with 118 adenomas (29 ampullary and 89 nonampullary) were included prospectively.

Results 15 lesions were small (12.7 %), 68 were large (57.6 %), and 35 were giant (29.7 %). Endoscopic prevention of delayed complications was performed in 81.4 % (n = 96) of all lesions and 94.3 % (n = 33) of giant lesions. Complete resection was achieved in 111 lesions (94.1 %). Complications were 22 delayed bleedings (18.6 %), 3 intraprocedural perforations (2.5 %), 2 delayed perforations (1.7 %), and 1 stricture (0.8 %). Major complications were associated with lesions size ≥ 30 mm (28.6 % vs. 9.6 %; P = 0.02) and ampullary adenomas (27.6 % vs. 11.2 %; P = 0.07). All minor bleeding and 75 % of major bleeding episodes were treated endoscopically; 25 % of major bleedings needed radiologic embolization. Two fatal courses were observed when delayed perforation occurred after EMR of giant lesions. Residual adenoma was detected in 20.4 % at first follow-up.

Conclusions EMR of giant duodenal neoplasia carries a substantial risk of major complications and recurrences. Resection technique and prevention of delayed complications need to be improved. Further measures should be evaluated in randomized studies.

Supplementary material



Publication History

Received: 09 December 2019

Accepted: 10 March 2020

Article published online:
14 April 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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