title: Cap-assisted EMR of large, sporadic, nonampullary duodenal polyps.
abstract: BACKGROUND
  EMR is an effective alternative to surgery for the removal of nonampullary duodenal polyps (NADPs). Cap-assisted EMR (EMR-C) has been rarely performed in the duodenum because of the risk of perforation.
  
  
  OBJECTIVE
  To evaluate the safety and effectiveness of EMR-C for the removal of large (≥ 15 mm) NADPs.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Tertiary-care referral center.
  
  
  METHODS
  Between 2000 and 2010, 26 consecutive patients with sporadic NADPs underwent EMR-C.
  
  
  METHODS
  EMR with the cap technique.
  
  
  METHODS
  Complete eradication of polyps, complications, and recurrence.
  
  
  RESULTS
  A total of 14 sessile polyps (53.8%), 7 lateral spreading type nongranular tumors (26.9%), and 5 lateral spreading type granular tumors (19.2%) were treated. The median size of lesions was 15 mm. Five lesions involved one-half of the luminal circumference. Post-EMR histologic assessment showed low-grade dysplasia in 5 patients (19.2%) and high-grade dysplasia in 18 patients (69.2%). Three patients (11.5%) had well-differentiated endocrine tumors. Complete eradication was obtained in 25 of 26 (96%) patients. No perforations occurred. Three cases of intraprocedural bleeding were managed endoscopically. Median follow-up was 6 years (range 1-10 years). Residual adenomatous tissue was observed in 3 patients in lesions of 50 mm. In one of these cases, an adenocarcinoma occurred after 8 months, which was managed surgically.
  
  
  CONCLUSIONS
  Retrospective design, single center.
  
  
  CONCLUSIONS
  This study supports the efficacy and safety of EMR-C for removing NADPs. Regular follow-up is mandatory because of the high risk of residual or recurrent adenomatous tissue and even cancer.
authors.affiliation: Department of Gastroenterology, General Hospital, Sanremo, Italy. mxconio@tin.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Conio
authors.forename: Antonella
authors.initials: A
authors.lastname: De Ceglie
authors.forename: Rosa
authors.initials: R
authors.lastname: Filiberti
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Fisher
authors.forename: Peter D
authors.initials: PD
authors.lastname: Siersema
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D004379:Duodenal Neoplasms / Q000473:pathology / Q000601:surgery*; D004384:Duodenoscopy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007417:Intestinal Polyps / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D062048:Narrow Band Imaging; D011230:Precancerous Conditions / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome