Prospective study of acute complication rates and associated risk factors in endoscopic therapy for duodenal adenomas.
BACKGROUND
Endoscopic therapy for duodenal adenomas is becoming increasingly important. However, only a few studies have been published on the topic, mainly with retrospective data.


METHODS
This prospective study was carried out to determine complication rates and associated risk factors during and after endoscopic therapy for duodenal adenomas. Between May 2011 and October 2012, 50 patients (with 61 duodenal adenomas) were included. Sixty-one duodenal adenomas were resected endoscopically. Complications (e.g., bleeding, pain, fever, pancreatitis, and perforation) were recorded. Associations between bleeding and other factors--sex, age, anticoagulation, location and size of adenomas, etiology, lesion morphology, resection type, and argon plasma coagulation (APC) for bleeding prophylaxis--were then investigated.


RESULTS
Bleeding was the main complication. Major bleeding occurred in four cases (6.5%) and minor bleeding in 11 (18%). One occult perforation also occurred. There was a statistically significant association between bleeding and the size of the adenoma (P = 0.012). APC for bleeding prophylaxis showed a promising trend, with an odds ratio of 0.31, reducing the bleeding risk by two-thirds in this study. However, due to the small number of six patients that received bleeding prophylaxis with APC therapy, this result was not statistically significant (P = 0.31).


CONCLUSIONS
Bleeding is the main complication in endoscopic therapy for duodenal adenomas. The bleeding risk increases significantly with adenoma size. Prophylactic APC seems to reduce the bleeding rate--however, because of the relatively small number of patients treated with APC, this partial result was not statistically relevant. Due to the relevant rate of complications, endoscopic resection of duodenal adenomas is only recommended in an in-patient setting.
Department of Internal Medicine II, HSK Wiesbaden (Teaching Hospital of the University of Mainz), Ludwig-Erhard-Strasse 100, 65199, Wiesbaden, Germany, insa.messer@googlemail.com.
Insa
I
Aschmoneit-Messer
Johannes
J
Richl
Jürgen
J
Pohl
Christian
C
Ell
Andrea
A
May
D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057908:Argon Plasma Coagulation; D004379:Duodenal Neoplasms / Q000473:pathology / Q000601:surgery*; D016145:Endoscopy, Digestive System / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000517:prevention & control; D011446:Prospective Studies; D012307:Risk Factors