title: Efficacy and safety of endoscopic mucosal resection of non-ampullary duodenal polyps: a systematic review.
abstract: OBJECTIVE
  Data on the safety and efficacy of endoscopic resection of non-ampullary duodenal polyps are limited. This study evaluated the safety and efficacy of endoscopic mucosal resection (EMR) of sporadic non-ampullary duodenal polyps.
  
  
  METHODS
  Relevant studies for the meta-analysis were identified through search of PUBMED and EMBASE databases. Studies employing EMR for the management of sporadic duodenal polyps in the non-ampullary region were included. The primary outcome was the surgical intervention rates due to non-curative endoscopic resection (incomplete removal/recurrence necessitating surgery) and/or management of procedural adverse events.
  
  
  RESULTS
  A total of 440 patients (485 duodenal polyps) from 14 studies were included. The mean size of the polyps was 13 mm to 35 mm. Surgical intervention due to non-curative EMR and adverse events was required in 2 % (95 % confidence interval [CI] 0 - 4 %). EMR was successfully accomplished in 93 % (95 %CI 89 - 97 %). The overall bleeding rate after EMR was 16 % (95 %CI 10 - 23 %), and the pooled delayed bleeding rate was 5 % (95 %CI 2 - 7 %). The overall incidence of perforation was 1 % (95 %CI 1 - 3 %). Over a median follow-up period of 6 - 72 months, the recurrence rate after EMR was 15 % (95 %CI 7 - 23 %). Six studies (pooled recurrence 20 %, 95 %CI 14 - 27 %) reported on the outcomes of managing recurrent polyps, for which endoscopic removal was successful in 62 % (95 %CI 37 - 87 %). There was no procedure related mortality.
  
  
  CONCLUSIONS
  EMR appears to be a safe and effective therapeutic option for management of sporadic non-ampullary duodenal polyps. Long-term endoscopic surveillance is required to manage and treat recurrent disease.
authors.affiliation: Center for Interventional Endoscopy, Orlando, FL, USA.
authors.forename: Udayakumar
authors.initials: U
authors.lastname: Navaneethan
authors.affiliation: Center for Interventional Endoscopy, Orlando, FL, USA.
authors.forename: Muhammad K
authors.initials: MK
authors.lastname: Hasan
authors.affiliation: Center for Interventional Endoscopy, Orlando, FL, USA; Department of Internal Medicine, Brandon Regional Hospital, Brandon, FL, USA.
authors.forename: Vennisvasanth
authors.initials: V
authors.lastname: Lourdusamy
authors.affiliation: Center for Interventional Endoscopy, Orlando, FL, USA.
authors.forename: Xiang
authors.initials: X
authors.lastname: Zhu
authors.affiliation: Center for Interventional Endoscopy, Orlando, FL, USA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Hawes
authors.affiliation: Center for Interventional Endoscopy, Orlando, FL, USA.
authors.forename: Shyam
authors.initials: S
authors.lastname: Varadarajulu