Outcomes of cold snare endoscopic mucosal resection of nonampullary duodenal adenomas ≥1 cm: a multicenter study

Natalie Wilson; Mohamed Abdallah; Allison R Schulman; Jeffrey D Mosko; Ahmed Saeed; Shivangi Kothari; Vivek Kaul; Truptesh H Kothari; Jennifer Phan; Anand Kumar; Christina Tofani; Raymond E Kim; Anders Westanmo; Benjamin M Moy; Frances Dang; Andrew Canakis; Neil Sharma; Thiruvengadam Muniraj; Nabeel Azeem; Mohammad Bilal

doi:10.1016/j.gie.2023.12.007

Outcomes of cold snare endoscopic mucosal resection of nonampullary duodenal adenomas ≥1 cm: a multicenter study

Gastrointest Endosc. 2023 Dec 11:S0016-5107(23)03151-6. doi: 10.1016/j.gie.2023.12.007. Online ahead of print.

Authors

Natalie Wilson¹, Mohamed Abdallah², Allison R Schulman³, Jeffrey D Mosko⁴, Ahmed Saeed⁵, Shivangi Kothari⁶, Vivek Kaul⁶, Truptesh H Kothari⁶, Jennifer Phan⁷, Anand Kumar⁸, Christina Tofani⁸, Raymond E Kim⁹, Anders Westanmo¹⁰, Benjamin M Moy¹¹, Frances Dang¹², Andrew Canakis⁹, Neil Sharma¹³, Thiruvengadam Muniraj¹⁴, Nabeel Azeem², Mohammad Bilal¹⁵

Affiliations

¹ Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
² Division of Gastroenterology and Hepatology, University of Minnesota, Minneapolis, Minnesota, USA.
³ Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA; Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.
⁴ Centre for Therapeutic Endoscopy and Endoscopic Oncology, St Michael's Hospital, Toronto, Ontario, Canada; Division of Gastroenterology and Hepatology, University of Toronto, Toronto, Ontario, Canada.
⁵ Division of Gastroenterology and Hepatology, HCA Midwest Health, Kansas City, Missouri, USA.
⁶ Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, New York, USA.
⁷ Division of Gastroenterology, University of Southern California, Los Angeles, California, USA.
⁸ Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
⁹ Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
¹⁰ Department of Pharmacy, Minneapolis Veteran Affairs Medical Center, Minneapolis, Minnesota, USA.
¹¹ University of Michigan Medical School, Ann Arbor, Michigan, USA.
¹² Division of Gastroenterology and Hepatology, University of Toronto, Toronto, Ontario, Canada.
¹³ Division of Interventional Oncology and Surgical Endoscopy (IOSE), Parkview Cancer Institute, Fort Wayne, Indiana, USA.
¹⁴ Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut, USA.
¹⁵ Division of Gastroenterology and Hepatology, Minneapolis Veteran Affairs Medical Center, Minneapolis, Minnesota, USA.

PMID: 38092125
DOI: 10.1016/j.gie.2023.12.007

Abstract

Background and aims: Endoscopic mucosal resection (EMR) with use of electrocautery (conventional EMR) has historically been used to remove large duodenal adenomas; however, use of electrocautery can predispose to adverse events including delayed bleeding and perforation. Cold snare EMR (cs-EMR) has been shown to be safe and effective for removal of colon polyps, but data regarding its use in the duodenum are limited. The aim of this study was to evaluate the efficacy and safety of cs-EMR for nonampullary duodenal adenomas ≥1 cm.

Methods: This was a multicenter retrospective study of patients with nonampullary duodenal adenomas ≥1 cm who underwent cs-EMR from October 2014 to May 2023. Patients who received any form of thermal therapy were excluded. Primary outcomes were technical success and rate of recurrent adenoma. Secondary outcomes were adverse events and predictors of recurrence.

Results: A total of 125 patients underwent resection of 127 nonampullary duodenal adenomas with cs-EMR. Follow-up data were available in 89 cases (70.1%). The recurrent adenoma rate was 31.5% (n = 28). Adverse events occurred in 3.9% (n = 5), with 4 cases of immediate bleeding (3.1%) and 1 case of delayed bleeding (.8%). There were no cases of perforation. The presence of high-grade dysplasia was found to be an independent predictor of recurrence (odds ratio, 10.9 [95% confidence interval, 1.1-102.1]; P = .036).

Conclusions: This retrospective multicenter study demonstrates that cs-EMR for nonampullary duodenal adenomas is safe and technically feasible with an acceptable recurrence rate. Future prospective studies are needed to directly compare outcomes of cs-EMR with conventional and underwater EMR.