title: Endoscopic mucosal resection of large and giant lateral spreading lesions of the duodenum: success, adverse events, and long-term outcomes.
abstract: OBJECTIVE
  Large sporadic duodenal adenomas are uncommon but they harbor malignant potential, which requires consideration of definitive treatment. EMR is gaining acceptance as an effective and safe alternative to high-risk surgical procedures, but data on long-term outcomes are limited. Herein we describe the short- and long-term outcomes of these lesions in a tertiary referral center.
  
  
  METHODS
  Prospectively collected data were analyzed to identify risk factors for adverse events and outcomes. Patient demographics, lesion characteristics, and procedural technical data were collected.
  
  
  RESULTS
  From 2007 to 2015, 106 adenomas ≥10 mm were resected (mean patient age, 69 years; 54% male; median size, 25 mm; interquartile range [IQR], 19-40). Complete endoscopic resection was achieved in 96%. Intraprocedural bleeding occurred in 43% of cases and was associated with lesion size (P < .001), number of resected specimens (P = .003), and longer procedures (P = .001). Delayed bleeding occurred in 15% (56% did not require active intervention) and was associated with lesion size (P = .03). Perforation occurred in 3 patients. The 30-day mortality was 0%. Median follow-up was 22 months (IQR, 7-45). Histologically proven adenoma recurrence was identified and treated in 12 of 83 patients (14.4%) on first surveillance endoscopy. For the 53 patients for whom follow-up ≥12 months was available (median follow-up, 36 months; IQR, 24-51), 48 patients (90.6%) were free of adenoma and considered cured.
  
  
  CONCLUSIONS
  In a tertiary referral center, endoscopic resection of duodenal adenomas is a safe and effective alternative to surgery. Lesion size is strongly associated with adverse events, particularly intraprocedural bleeding and delayed bleeding. Good long-term outcomes are demonstrated.
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, Sydney, New South Wales, Australia.
authors.forename: Amir
authors.initials: A
authors.lastname: Klein
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, Sydney, New South Wales, Australia.
authors.forename: Dhruv
authors.initials: D
authors.lastname: Nayyar
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, Sydney, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Farzan F
authors.initials: FF
authors.lastname: Bahin
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, Sydney, New South Wales, Australia.
authors.forename: Zhengyan
authors.initials: Z
authors.lastname: Qi
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, Sydney, New South Wales, Australia.
authors.forename: Eric
authors.initials: E
authors.lastname: Lee
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, Sydney, New South Wales, Australia.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Williams
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, Sydney, New South Wales, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Byth
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, Sydney, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bourke
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D016063:Blood Loss, Surgical; D004379:Duodenal Neoplasms / Q000473:pathology / Q000601:surgery*; D000069916:Endoscopic Mucosal Resection / Q000009:adverse effects; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000601:surgery; D019106:Postoperative Hemorrhage / Q000209:etiology*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden