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World J Gastrointest Endosc. Jun 25, 2015; 7(7): 720-727
Published online Jun 25, 2015. doi: 10.4253/wjge.v7.i7.720
Endoscopic mucosal resection and endoscopic submucosal dissection in the treatment of sporadic nonampullary duodenal adenomatous polyps
Joana Marques, Francisco Baldaque-Silva, Pedro Pereira, Urban Arnelo, Naohisa Yahagi, Guilherme Macedo
Joana Marques, Faculty of Medicine, University of Porto, 4200 Porto, Portgal
Francisco Baldaque-Silva, Gastrocentrum Karolinska University Hospital, Karolinska Institutet, S-14186 Stockholm, Sweden
Pedro Pereira, Guilherme Macedo, Gastroenterology Department, Hospital São João, 4200 Porto, Portugal
Urban Arnelo, Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, and Centre for Digestive Diseases, Karolinska University Hospital, S-14186 Stockholm, Sweden
Naohisa Yahagi, Division of Research and Development for Minimally Invasive Treatment, Cancer Center, School of Medicine, Keio University, Shinjuku-ku, Tokyo 160-8582, Japan
Author contributions: All the authors contributed to this manuscript.
Conflict-of-interest: The authors declare no conflict of interests related to this paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Francisco Baldaque-Silva, MD, Gastrocentrum Karolinska University Hospital, Karolinska Institutet, Karolinska vägen, S-14186 Stockholm, Sweden. fbaldaquesilva@gmail.com
Telephone: +46-08-58586902 Fax: +46-08-58582489
Received: October 29, 2014
Peer-review started: November 2, 2014
First decision: December 12, 2014
Revised: April 16, 2015
Accepted: May 16, 2015
Article in press: May 18, 2015
Published online: June 25, 2015
Processing time: 252 Days and 4.2 Hours
Abstract

Although uncommon, sporadic nonampullary duodenal adenomas have a growing detection due to the widespread of endoscopy. Endoscopic therapy is being increasingly used for these lesions, since surgery, considered the standard treatment, carries significant morbidity and mortality. However, the knowledge about its risks and benefits is limited, which contributes to the current absence of standardized recommendations. This review aims to discuss the efficacy and safety of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) in the treatment of these lesions. A literature review was performed, using the Pubmed database with the query: “(duodenum or duodenal) (endoscopy or endoscopic) adenoma resection”, in the human species and in English. Of the 189 retrieved articles, and after reading their abstracts, 19 were selected due to their scientific interest. The analysis of their references, led to the inclusion of 23 more articles for their relevance in this subject. The increased use of EMR in the duodenum has shown good results with complete resection rates exceeding 80% and low complication risk (delayed bleeding in less than 12% of the procedures). Although rarely used in the duodenum, ESD achieves close to 100% complete resection rates, but is associated with perforation and bleeding risk in up to one third of the cases. Even though literature is insufficient to draw definitive conclusions, studies suggest that EMR and ESD are valid options for the treatment of nonampullary adenomas. Thus, strategies to improve these techniques, and consequently increase the effectiveness and safety of the resection of these lesions, should be developed.

Keywords: Polyps; Duodenum; Adenoma; Resection; Endoscopy

Core tip: Widespread use of endoscopy leads to increase detection of sporadic nonampullary duodenal adenomas. Due to significant morbidity and mortality of surgical treatment in this setting, endoscopic treatment with endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), has been progressively used for the resection of these lesions. This extensive and detailed review discusses the efficacy and safety of EMR and ESD in this context. We conclude that EMR and ESD are valid options for the treatment of sporadic nonampullary duodenal adenomas. Strategies to improve these techniques, and consequently increase their effectiveness and safety should be developed.