Prospective Evaluation of Complications After Endoscopic Mucosal Resection (EMR) of Superficial Non-Ampullary Duodenal Epithelial Tumors (Snadets)

Aims SNADETs are rare lesions, with poorly standardized resection techniques. The complication rates after EMR range from 10.5 to 41.3 %. The aim of our work was to evaluate the efficacy and safety of EMR of non-ampullary duodenal adenomas.

Methods Consecutive patients of a tertiary digestive endoscopy center from January 2015 to December 2020 were analyzed. This is a retrospective study of a prospectively collected database. Patients who had resections for ampullary, non-adenomatous, or infracentimetric lesions were excluded. Clinical and endoscopic patient data were extracted from computerized medical records.

Results 184 patients were treated with a mean age of 61.8 years and a median ASA score of 2. 55/184(29.9 %) had a genetic predisposition syndrome, of which 35/184(19 %) had familial adenomatous polyposis. The median (range) lesion size was 25mm(10-90mm).

EMR was performed in 179/184(97.3 %) of cases with an en-bloc resection rate of 76/184(41.3 %) and an endoscopic complete resection rate of 165/184(89.7 %). To prevent complication’s risk, EMR closure was performed in 69/184(37.5 %) of the cases and hemostatic treatment in 144/184(78.3 %). 36/184(19.6 %) complications were recorded, including 28/184(15.2 %) of immediate bleeding, 6/184(3.3 %) of immediate perforation, 4/184(2.2 %) of delayed perforation, 14/184(7.6 %) of severe complications without any death at D30. Complication rate was 7/69(10.1 %) for closed lesions by hemoclips versus 27/113(23.9 %) without hemoclip (p=0.03), and 11/51(21.2 %) for lesions of patients with genetic predisposition syndrome versus 25/133(18.7 %) without (p=0.68). 71/184(38.6 %) local recurrence was found after a median follow-up of 12.6 months, 21/76(27.6 %) in the en-bloc resected group and 50/108(46.3 %) in the piecemeal resected group (p=0.014), and 23/71(32.4 %) endoscopic remission was obtained after a median of 2 procedures.

Conclusions EMR of SNADETs has a 20 % morbidity, similar in patients with genetic predisposition syndromes or sporadic lesions. Placement of hemoclip significantly reduces the complication rates. The high local recurrence rate, also observed after en-bloc resections, should lead to consider alternative endoscopic resection techniques.

Citation: Amoyel M, Belle A, Dhooge M etal. eP280 PROSPECTIVE EVALUATION OF COMPLICATIONS AFTER ENDOSCOPIC MUCOSAL RESECTION (EMR) OF SUPERFICIAL NON-AMPULLARY DUODENAL EPITHELIAL TUMORS (SNADETS). Endoscopy 2021; 53: S190.

Publication History

Article published online:
19 March 2021