title: Efficacy and safety of the band and slough technique for endoscopic therapy of nonampullary duodenal adenomas: a case series.
abstract: BACKGROUND
  Endoscopic resection of nonampullary duodenal adenomas (NADAs) is effective but carries substantial procedural risks. Therapeutic banding for treatment of duodenal mucosal neoplasia has not been studied. We report a novel band and slough (BAS) technique for therapy of NADA without endoscopic resection.
  
  
  OBJECTIVE
  Efficacy and safety of BAS.
  
  
  METHODS
  Retrospective review of a prospective database.
  
  
  METHODS
  Community hospital.
  
  
  METHODS
  Patients with sporadic and familial biopsy-proven NADA without invasive cancer undergoing BAS.
  
  
  METHODS
  Patients were treated with BAS without endoscopic resection on an outpatient basis. A follow-up telephone call was made by a nurse at 24 hours. Follow-up endoscopy was performed at 8 weeks, with further therapy of residual NADA. In patients with minimal residual NADA not amenable to banding, argon plasma coagulation (APC) "touch-up" was used. Subsequent endoscopic surveillance was performed.
  
  
  METHODS
  Complete histologic remission of NADA after successful BAS and postprocedure bleeding, perforation, and pain.
  
  
  RESULTS
  Ten patients, average age 65 years, 6 male, with sporadic/familial adenomatous polyposis NADA 8 of 2 (6 tubular adenoma and 4 tubulovillous adenoma) were treated. Mean (largest) NADA was 12.5 mm (20 mm). Five patients achieved complete remission after a single session. Among 5 patients requiring further therapy, 3 were treated with repeat banding with or without APC and 2 with APC alone. The average number of bands per session was 4.4. Patients were followed up to 24 months without NADA recurrence. None of the patients had acute or delayed adverse events of bleeding, perforation, or postprocedure pain.
  
  
  CONCLUSIONS
  Lack of polyp tissue retrieval.
  
  
  CONCLUSIONS
  BAS appears to be a safe and potentially effective endoscopic treatment for NADA. However, larger studies are needed to corroborate these findings.
authors.affiliation: Department of Internal Medicine, St. Joseph Mercy Hospital, Ypsilanti, Michigan, USA.
authors.forename: Thoyaja
authors.initials: T
authors.lastname: Koritala
authors.affiliation: Department of Gastroenterology, Huron Gastroenterology, St. Joseph Mercy Hospital, Ypsilanti, Michigan, USA.
authors.forename: Eugene
authors.initials: E
authors.lastname: Zolotarevsky
authors.affiliation: Department of Pathology, St. Joseph Mercy Hospital, Ypsilanti, Michigan, USA.
authors.forename: Angela N
authors.initials: AN
authors.lastname: Bartley
authors.affiliation: Department of Gastroenterology, Huron Gastroenterology, St. Joseph Mercy Hospital, Ypsilanti, Michigan, USA.
authors.forename: Carla D
authors.initials: CD
authors.lastname: Ellis
authors.affiliation: Department of Gastroenterology, Huron Gastroenterology, St. Joseph Mercy Hospital, Ypsilanti, Michigan, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Krolikowski
authors.affiliation: Department of Gastroenterology, Huron Gastroenterology, St. Joseph Mercy Hospital, Ypsilanti, Michigan, USA.
authors.forename: Jill
authors.initials: J
authors.lastname: Burton
authors.affiliation: Department of Gastroenterology, Huron Gastroenterology, St. Joseph Mercy Hospital, Ypsilanti, Michigan, USA.
authors.forename: Naresh T
authors.initials: NT
authors.lastname: Gunaratnam
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057908:Argon Plasma Coagulation; D004379:Duodenal Neoplasms / Q000473:pathology / Q000628:therapy*; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D019233:Retreatment; D012189:Retrospective Studies; D047368:Tumor Burden