title: Safety and efficacy of EMR for sporadic, nonampullary duodenal adenomas: a single U.S. center experience (with video).
abstract: OBJECTIVE
  EMR is increasingly used for resection of sporadic, nonampullary duodenal adenomas (SNDAs), but there are no guidelines for the management of these lesions. The aims of this study were to evaluate the safety and efficacy of EMR exclusively for SNDAs and to determine the factors predictive of outcomes.
  
  
  METHODS
  We performed a retrospective review of patients with SNDAs referred for endoscopic therapy from 2006 to 2013. The outcomes studied were successful endoscopic resection, major adverse events, early and late recurrences, and clinical remission.
  
  
  RESULTS
  Sixty-eight patients with SNDAs were included and 51 (75%) underwent EMR. The mean adenoma size was 22.0 ± 8.9 mm. Successful resection was achieved in 49 of 51 patients (96.1%), and major adverse events were noted in 8 of 51 patients (15.7%). Early and late recurrences were noted in 25.6% and 5.2% of patients, respectively, and were treated endoscopically. Clinical remission was achieved in 89.7% of patients after a median follow-up of 15 months. Presence of villous histology was associated with increased recurrence (P = .019), but no association of recurrence was noted with other endoscopic features or resection technique. Large adenoma size (P = .0057) and need for intraprocedural hemostasis (P = .006) were associated with increased adverse events, but no association of adverse events was noted with location or resection technique.
  
  
  CONCLUSIONS
  Large duodenal adenomas can be effectively managed with EMR at a referral center with experienced endoscopists. However, EMR has a significant recurrence rate, especially early recurrence, and the risk of adverse events is not negligible. Endoscopic therapy is successful in managing recurrent adenomas.
authors.affiliation: Center for Endoscopic Research and Therapeutics (CERT), University of Chicago, Chicago, Illinois, USA.
authors.forename: Ajaypal
authors.initials: A
authors.lastname: Singh
authors.affiliation: Center for Endoscopic Research and Therapeutics (CERT), University of Chicago, Chicago, Illinois, USA.
authors.forename: Uzma D
authors.initials: UD
authors.lastname: Siddiqui
authors.affiliation: Center for Endoscopic Research and Therapeutics (CERT), University of Chicago, Chicago, Illinois, USA.
authors.forename: Vani J
authors.initials: VJ
authors.lastname: Konda
authors.affiliation: Department of Pathology, University of Chicago, Chicago, Illinois, USA.
authors.forename: Emma
authors.initials: E
authors.lastname: Whitcomb
authors.affiliation: Department of Pathology, University of Chicago, Chicago, Illinois, USA.
authors.forename: John
authors.initials: J
authors.lastname: Hart
authors.affiliation: Department of Pathology, University of Chicago, Chicago, Illinois, USA.
authors.forename: Shu-Yuan
authors.initials: SY
authors.lastname: Xiao
authors.affiliation: Center for Endoscopic Research and Therapeutics (CERT), University of Chicago, Chicago, Illinois, USA.
authors.forename: Mariano G
authors.initials: MG
authors.lastname: Ruiz
authors.affiliation: Center for Endoscopic Research and Therapeutics (CERT), University of Chicago, Chicago, Illinois, USA.
authors.forename: Ann
authors.initials: A
authors.lastname: Koons
authors.affiliation: Center for Endoscopic Research and Therapeutics (CERT), University of Chicago, Chicago, Illinois, USA.
authors.forename: Irving
authors.initials: I
authors.lastname: Waxman
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*; D000069916:Endoscopic Mucosal Resection / Q000009:adverse effects; D016099:Endoscopy, Gastrointestinal; D005260:Female; D016558:Hemostasis, Endoscopic; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden