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Outcomes of thermal ablation of the defect margin after duodenal endoscopic mucosal resection (with videos)

Published:December 04, 2020DOI:https://doi.org/10.1016/j.gie.2020.11.024

      Background and Aims

      Laterally spreading lesions (LSLs) in the duodenum are conventionally treated by EMR. Recurrence is commonly encountered and can be difficult to treat safely due to the unique anatomic characteristics of the duodenum. Auxiliary techniques designed to prevent recurrence have not been described.

      Methods

      We sought to evaluate the effectiveness of thermal ablation of the defect margin after EMR (EMR-T) in reducing recurrence at first surveillance endoscopy (SE1, scheduled at 6 months) in a single tertiary referral center. All duodenal LSLs ≥10 mm referred for EMR were eligible. After successful EMR, thermal ablation was performed using snare-tip soft coagulation around the entire circumference of the resection defect. The primary outcome was the frequency of recurrence at SE1. A previous, well-characterized, prospective cohort of duodenal LSLs ≥10 mm treated by conventional EMR was the comparator.

      Results

      Over 43 months up to October 2019, 54 LSLs underwent EMR-T. One hundred twenty-five LSLs underwent conventional EMR in the comparator group. Patient and lesion characteristics were similar between the groups. Recurrence was significantly lower in the EMR-T group compared with the conventional EMR group (1 of 49 [2.3%] vs 19 of 108 [17.6%]; P = .01). No difference in technical success, EMR-related adverse outcomes, or referral to surgery were identified between the groups.

      Conclusions

      EMR-T significantly reduces the frequency of recurrence for duodenal LSLs. This technique is safe in the duodenum and has the potential to significantly improve the effectiveness of duodenal EMR. (Clinical trial registration number: NCT02306603.)

      Abbreviations:

      ASA (American Society of Anesthesiologists), CAST (cold-forceps avulsion with adjuvant snare-tip soft coagulation), CSPEB (clinically significant postendoscopic bleeding), DMI (deep mural injury), EMR-T (thermal ablation of the defect margin after EMR), IPB (intraprocedural bleeding), IQR (interquartile range), LSL (laterally spreading lesion), LSL-P (papillary laterally spreading lesion), RRA (residual or recurrent adenoma), SE1 (surveillance endoscopy 1), STSC (snare-tip soft coagulation)
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      Linked Article

      • The key to reducing residual or recurrent adenoma after duodenal EMR is remembering to spice up the rim
        Gastrointestinal EndoscopyVol. 93Issue 6
        • Preview
          Large duodenal adenomas, particularly laterally spreading lesions (LSLs), present unique challenges when endoscopic resection is planned. To date, there are few studies assessing the efficacy, optimal technique, or safety of EMR in the duodenum, and the clinical techniques used in duodenal EMR are derived largely from EMR of colorectal lesions, which are more common. However, the duodenum has several key differences from the colorectum, so the strategies and techniques used in colorectal EMR may not all be directly applicable to duodenal EMR.
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