Cap-assisted EMR of large, sporadic, nonampullary duodenal polyps

Abstract

Background: EMR is an effective alternative to surgery for the removal of nonampullary duodenal polyps (NADPs). Cap-assisted EMR (EMR-C) has been rarely performed in the duodenum because of the risk of perforation.

Objective: To evaluate the safety and effectiveness of EMR-C for the removal of large (≥ 15 mm) NADPs.

Design: Retrospective study.

Setting: Tertiary-care referral center.

Patients: Between 2000 and 2010, 26 consecutive patients with sporadic NADPs underwent EMR-C.

Intervention: EMR with the cap technique.

Main outcome measurements: Complete eradication of polyps, complications, and recurrence.

Results: A total of 14 sessile polyps (53.8%), 7 lateral spreading type nongranular tumors (26.9%), and 5 lateral spreading type granular tumors (19.2%) were treated. The median size of lesions was 15 mm. Five lesions involved one-half of the luminal circumference. Post-EMR histologic assessment showed low-grade dysplasia in 5 patients (19.2%) and high-grade dysplasia in 18 patients (69.2%). Three patients (11.5%) had well-differentiated endocrine tumors. Complete eradication was obtained in 25 of 26 (96%) patients. No perforations occurred. Three cases of intraprocedural bleeding were managed endoscopically. Median follow-up was 6 years (range 1-10 years). Residual adenomatous tissue was observed in 3 patients in lesions of 50 mm. In one of these cases, an adenocarcinoma occurred after 8 months, which was managed surgically.

Limitations: Retrospective design, single center.

Conclusion: This study supports the efficacy and safety of EMR-C for removing NADPs. Regular follow-up is mandatory because of the high risk of residual or recurrent adenomatous tissue and even cancer.