Endoscopic mucosal resection and endoscopic submucosal dissection in the treatment of sporadic nonampullary duodenal adenomatous polyps

作     者：Joana Marques Francisco Baldaque-Silva Pedro Pereira Urban Arnelo Naohisa Yahagi Guilherme Macedo 

作者机构：Faculty of Medicine University of Porto Gastrocentrum Karolinska University Hospital Karolinska Institutet Gastroenterology Department Hospital Sao Joao Department of Clinical Science Intervention and Technology (CLINTEC) Karolinska Institutet and Centre for Digestive Diseases Karolinska University Hospital Division of Research and Development for Minimally Invasive Treatment Cancer Center School of Medicine Keio University 

出 版 物：《World Journal of Gastrointestinal Endoscopy》 (世界胃肠内镜杂志（英文版）（电子版）)

年 卷 期：2015年第7卷第7期

页      面：720-727页

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：息肉 十二指肠 腺瘤 切除术 内视镜检查法 

摘      要：Although uncommon, sporadic nonampullary duodenal adenomas have a growing detection due to the widespread of endoscopy. Endoscopic therapy is being increasingly used for these lesions, since surgery, considered the standard treatment, carries significant morbidity and mortality. However, the knowledge about its risks and benefits is limited, which contributes to the current absence of standardized recommendations. This review aims to discuss the efficacy and safety of endoscopic mucosal resection(EMR) and endoscopic submucosal dissection(ESD) in the treatment of these lesions. A literature review was performed, using the Pubmed database with the query: (duodenum or duodenal)(endoscopy or endoscopic) adenoma resection, in the human species and in English. Of the 189 retrieved articles, and after reading their abstracts, 19 were selected due to their scientific interest. The analysis of their references, led to the inclusion of 23 more articles for their relevance in this subject. The increased use of EMR in the duodenum has shown good results with complete resection rates exceeding 80% and low complication risk(delayed bleeding in less than 12% of the procedures). Although rarely used in the duodenum, ESD achieves close to 100% complete resection rates, but is associated with perforation and bleeding risk in up to one third of the cases. Even though literature is insufficient to draw definitive conclusions, studies suggest that EMR and ESD are valid options for the treatment of nonampullary adenomas. Thus, strategies to improve these techniques, and consequently increase the effectiveness and safety of the resection of these lesions, should be developed.