Endoscopic resection for the treatment of duodenal Brunner's adenomas.
OBJECTIVE
Brunner's adenoma is a rare benign tumor of the duodenum. The traditional management option was close follow-up and surgical tumor resection. With the development of endoscopy devices and techniques, endoscopic resection is considered an alternative treatment option. However, whether small lesions require treatment has been controversial. We planned to study the feasibility, efficacy, and safety of endoscopic resection for the treatment of Brunner's adenomas.


METHODS
In total, 30 Brunner's adenomas from 29 patients were treated with endoscopic resection between August 2007 and June 2011 in our hospital. Endoscopic ultrasonography (EUS) was performed preoperatively to evaluate tumor origin and size. Tumor characteristics, complications, en bloc resection rate, and local recurrence rates were evaluated.


RESULTS
Of the 29 patients, 13 (44.8%) were men. The median age was 55 years (range, 29-72 years). The mean maximal dimension of the lesions was 1.7±0.1 cm (range, 0.6-7 cm). Overall, 9 lesions were treated with snare resection, 12 lesions were treated with conventional endoscopic mucosal resection (EMR), and 9 lesions were treated with endoscopic submucosal dissection (ESD). Only 1 case of delayed bleeding occurred on Day 2 after EMR. The en bloc resection rate was 100% (30/30). One lesion resected by EMR exhibited indeterminate tumor margins. The overall curative resection rate was 96.7% (29/30). During the follow-up period (median time, 13 months; range, 2-39 months), 1 patient, whose tumor exhibited indeterminate margins, showed recurrence 1 year after EMR; ESD was recommended. No recurrence was observed during the subsequent follow-up period.


CONCLUSIONS
Our study provides evidence of the efficacy of endoscopic resection for the localized treatment of duodenal Brunner's gland adenomas with relatively few complications and a low mortality rate.
Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai, China.
Yun-Shi
YS
Zhong
Qiang
Q
Shi
Hai-Fu
HF
Wu
Li-Qing
LQ
Yao
Ping-Hong
PH
Zhou
Mei-Dong
MD
Xu
Shi-Yao
SY
Chen
D000236:Adenoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D002011:Brunner Glands / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D004379:Duodenal Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies