Endoscopic predictors of successful endoluminal eradication in sporadic duodenal adenomas and its acute complications.
BACKGROUND
Sporadic duodenal adenomas (SDA) are mucosal neoplasms with malignant potential. Endoscopic eradication used both resection and ablation techniques. Optimal predictors, tools, and techniques for endoscopic eradication of SDA have not been determined.


OBJECTIVE
To determine endoscopic predictors of successful endoscopic eradication therapy and the acute complication profile of this therapy.


METHODS
This is a retrospective cohort analysis of 36 consecutive patients referred for management of SDA at a tertiary-care center by a single practitioner.


METHODS
Single-site study.


METHODS
This study involved adult patients referred for endoscopic management of SDA.


METHODS
Endoluminal snare resection was individualized and performed with or without submucosal injection in en bloc or piecemeal fashion.


METHODS
Variables including demographics, endoscopic features of the tumors, and eradication techniques applied were measured against outcomes of complete resection and acute bleeding.


RESULTS
Among 36 patients, 11 were male and 25 female, with a mean age of 65.3 ± 11.1 years. Of 33 patients who underwent attempted endoscopic resection, complete resection was achieved in 23 cases (69.7%). Statistically significant negative predictors of complete resection were age >70.5 years (P = .0302), application of argon plasma coagulation (P = .046), and increasing luminal circumference involved by tumors (P < .0001), whereas use of submucosal injection (P = .0121), snare cautery (P < .001), and en bloc resection (P < .001) were positively associated with complete eradication. There were no significant predictors of acute bleeding.


CONCLUSIONS
This is a retrospective analysis of a single operator's experience.


CONCLUSIONS
The extent of luminal circumference involved by the tumor is the strongest predictor of successful eradication. This predictor can guide management of SDA.
Division of Gastroenterology, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Prashant
P
Kedia
Colleen
C
Brensinger
Gregory
G
Ginsberg
D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D015331:Cohort Studies; D004379:Duodenal Neoplasms / Q000473:pathology / Q000601:surgery*; D004384:Duodenoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011379:Prognosis; D012189:Retrospective Studies; D013525:Surgical Instruments