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• W2979124955 abstract "Introduction: Although EMR is an effective alternative to surgery for NADA, it is considered a difficult technique for feared complications. The objective is to evaluate the safety and effectiveness of EMR and EMR-C for large duodenal polyps. Methods: Data were retrospectively obtained. Subjects were included if a pathology report confirmed duodenal adenoma, resected by EMR or EMR-C. All cases of EMR-C were performed by one expert with a reduced strength of suction. The base of EMR or EMR-C site was treated with coagulation. In general, repeat endoscopy was performed in 3 months. Results: A total of 220 patients were found to have duodenal adenomas. Of 220, a total of 57 underwent resection, 37 EMR and 20 EMR-C; 15 with FAP [8F, mean age 47 (22-77)] and 42 with SDA [20F, mean age 60 (22-84)]. Length of follow up was 30(0-118) mo for FAP and 22(0-99) mo for SDA. For FAP, the mean polyp size was size 24 mm (10-45mm) with 3 recurrence on follow-up (No follow up data were available in 1). On initial pathology, there were 4 tubular adenomas (TA) and 11 tubulovillous adenomas (TVA), 7 of which had high-grade dysplasia (HGD) within the FAP. The deep margin was positive in 1, and the lateral margins were positive in 4. For SDA, the mean polyp size was 25 mm (5-70 mm) with no recurrence. There were 15 TAs, 23 TVAs, 1 intramucosal adenocarcinoma, 1 villous adenoma, 1 pancreatic heterotopia, 12 of which had HGD. The deep margin was positive in 3, and lateral margins were positive in 12. The recurrence rate after EMR and EMR-C was 3/57 (5.3%). 2 early complications were seen. 1 had perforation with EMR, which was surgically managed by primary duodenal repair. 1 patient with EMR-C had clinically significant bleeding (requiring 1 u of blood transfusion) and was endoscopically managed within 24 hours. There was 1 delayed perforation with EMR after 2 days in a patient who was extensively treated with APC at an outside facility prior to EMR; this was surgically managed. No mortality was noted. Conclusion: EMR and EMR-C appear to have similar acceptable safety and efficacy for removing NADA when performed by experienced endoscopists. When performing EMR-C, a controlled suction, rather than a full suction, should be applied in order to prevent perforation. In these techniques, however, the lateral margin positivity cannot be accurately assessed as multiple segments are created in removing a large polyp. Therefore, meticulous follow-up is needed for surveillance of recurrence and/or assessment of residual polyps." @default.
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• W2979124955 date "2015-10-01" @default.
• W2979124955 modified "2023-09-27" @default.
• W2979124955 title "Cap-Assisted Endoscopic Mucosal Resection (EMR-C) and Conventional EMR for Large, Nonampullary Duodenal Polyps (NADA) in Patients With Familial Adenomatous Polyposis (FAP) or Sporadic Duodenal Adenoma (SDA)" @default.
• W2979124955 doi "https://doi.org/10.14309/00000434-201510001-02436" @default.
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