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Efficacy and safety of the band and slough technique for endoscopic therapy of nonampullary duodenal adenomas: a case series

Published:November 22, 2014DOI:https://doi.org/10.1016/j.gie.2014.09.043

      Background

      Endoscopic resection of nonampullary duodenal adenomas (NADAs) is effective but carries substantial procedural risks. Therapeutic banding for treatment of duodenal mucosal neoplasia has not been studied. We report a novel band and slough (BAS) technique for therapy of NADA without endoscopic resection.

      Objective

      Efficacy and safety of BAS.

      Design

      Retrospective review of a prospective database.

      Setting

      Community hospital.

      Patients

      Patients with sporadic and familial biopsy-proven NADA without invasive cancer undergoing BAS.

      Intervention

      Patients were treated with BAS without endoscopic resection on an outpatient basis. A follow-up telephone call was made by a nurse at 24 hours. Follow-up endoscopy was performed at 8 weeks, with further therapy of residual NADA. In patients with minimal residual NADA not amenable to banding, argon plasma coagulation (APC) “touch-up” was used. Subsequent endoscopic surveillance was performed.

      Main Outcome Measurements

      Complete histologic remission of NADA after successful BAS and postprocedure bleeding, perforation, and pain.

      Results

      Ten patients, average age 65 years, 6 male, with sporadic/familial adenomatous polyposis NADA 8 of 2 (6 tubular adenoma and 4 tubulovillous adenoma) were treated. Mean (largest) NADA was 12.5 mm (20 mm). Five patients achieved complete remission after a single session. Among 5 patients requiring further therapy, 3 were treated with repeat banding with or without APC and 2 with APC alone. The average number of bands per session was 4.4. Patients were followed up to 24 months without NADA recurrence. None of the patients had acute or delayed adverse events of bleeding, perforation, or postprocedure pain.

      Limitations

      Lack of polyp tissue retrieval.

      Conclusion

      BAS appears to be a safe and potentially effective endoscopic treatment for NADA. However, larger studies are needed to corroborate these findings.

      Abbreviations:

      APC (argon plasma coagulation), BAS (band and slough), ER (endoscopic resection), NADA (nonampullary duodenal adenoma)
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