Efficacy and Long-Term Outcome of Endoscopic Treatment of Sporadic Nonampullary Duodenal Adenoma
1
조회
0
다운로드
1
인용
0
참고문헌
초록
Background/Aims: Endoscopic resection has proven to be a safe and effective alternative to surgery for duodenal adenomas. However, few data are available on the adequacy of resection and long-term outcomes. This study evaluated the efficacy and longterm endoscopic findings in a cohort of Korean patients who underwent endoscopic mucosal resection (EMR) of sporadic duodenal adenomas. Methods:Seventeen patients with nonampullary duodenal adenomas without familial polyposis syndrome and who were treated by EMR between January 2001 and December 2007 were evaluated retrospectively. Their management, follow-up, and outcomes were reviewed. Results: In total, seventeen lesions were removed from EMR in 17 patients (mean age, 59.3 years; 6women, 11 men). The mean size of the tumors was 15.1 mm (median, 13 mm, range, 8-27 mm). Of these 17 adenomas, 16 adenomas were tubulous and 1 was tubulovillous. The EMR was performed successfully in all 17 patients in a single session. After a median follow-up period of 29 months (range, 13-72 months), all patients remained in remission. One patient had bleeding at the site of the EMR. There were no perforations after the EMR. Conclusions: EMR for sporadic duodenal adenomas seemed to be a safe and effective treatment modality.
Abstract
Background/Aims: Endoscopic resection has proven to be a safe and effective alternative to surgery for duodenal adenomas. However, few data are available on the adequacy of resection and long-term outcomes. This study evaluated the efficacy and longterm endoscopic findings in a cohort of Korean patients who underwent endoscopic mucosal resection (EMR) of sporadic duodenal adenomas. Methods:Seventeen patients with nonampullary duodenal adenomas without familial polyposis syndrome and who were treated by EMR between January 2001 and December 2007 were evaluated retrospectively. Their management, follow-up, and outcomes were reviewed. Results: In total, seventeen lesions were removed from EMR in 17 patients (mean age, 59.3 years; 6women, 11 men). The mean size of the tumors was 15.1 mm (median, 13 mm, range, 8-27 mm). Of these 17 adenomas, 16 adenomas were tubulous and 1 was tubulovillous. The EMR was performed successfully in all 17 patients in a single session. After a median follow-up period of 29 months (range, 13-72 months), all patients remained in remission. One patient had bleeding at the site of the EMR. There were no perforations after the EMR. Conclusions: EMR for sporadic duodenal adenomas seemed to be a safe and effective treatment modality.
참고문헌 (26)
- Yao T, "Duodenal lesions in familial polyposis of the colon", Gastroenterology, 73, pp.1086~1092 (1977)
- Sarre RG, "Gastric and duodenal polyps in familial adenomatous polyposis: a prospective study of the nature and prevalence of upper gastrointestinal polyps", Gut, 28, pp.306~314 (1987)
- Domizio P, "Upper gastrointestinal pathology in familial adenomatous polyposis: results from a prospective study of 102 patients", J Clin Pathol, 43, pp.738~743 (1990)
- Höchter W, "Duodenal polyps. Incidence, histologic substrate and significance", Dtsch Med Wochenschr, 109, pp.1183~1186 (1984)
- Jepsen JM, "Prospective study of prevalence and endoscopic and histopathologic characteristics of duodenal polyps in patients submitted to upper endoscopy", Scand J Gastroenterol, 29, pp.483~487 (1994)
- Sellner F, "Investigations on the significance of the adenoma-carcinoma sequence in the small bowel", Cancer, 66, pp.702~705 (1990)
- Sakorafas GH, "Villous tumors of the duodenum: biologic characters and clinical implications", Scand J Gastroenterol, 35, pp.337~344 (2000)
- Perzin KH, "Adenomas of the small intestine: a clinicopathologic review of 51 cases and a study of their relationship to carcinoma", Cancer, 48, pp.799~819 (1981)
- Krukowski ZH, "Operative management of tubulovillous neoplasms of the duodenum and ampulla", Br J Surg, 75, pp.150~153 (1988)
- Galandiuk S, "Villous tumors of the duodenum", Ann Surg, 207, pp.234~239 (1988)
- Ghilain JM, "Endoscopic laser therapy for small villous adenomas of the duodenum", Endoscopy, 26, pp.308~310 (1994)
- Farnell MB, "Villous tumors of the duodenum: reappraisal of local vs. extended resection", J Gastrointest Surg, 4, pp.13~21 (2000)
- Apel D, "Follow-up after endoscopic snare resection of duodenal adenomas", Endoscopy, 37, pp.444~448 (2005)
- Haubrich WS, "Endoscopic removal of a duodenal adenoma", Gastrointest Endosc, 19, pp.201~ (1973)
- Hirasawa R, "Clinicopathologic features and endoscopic resection of duodenal adenocarcinomas and adenomas with the submucosal saline injection technique", Gastrointest Endosc, 46, pp.507~513 (1997)
- Ahmad NA, "Efficacy, safety, and clinical outcomes of endoscopic mucosal resection: a study of 101 cases", Gastrointest Endosc, 55, pp.390~396 (2002)
- Oka S, "Clinicopathologic features and endoscopic resection of early primary nonampullary duodenal carcinoma", J Clin Gastroenterol, 37, pp.381~386 (2003)
- Lépilliez V, "Endoscopic resection of sporadic duodenal adenomas: an efficient technique with a substantial risk of delayed bleeding", Endoscopy, 40, pp.806~810 (2008)
- Alexander S, "EMR of large, sessile, sporadic nonampullary duodenal adenomas: technical aspects and long-term outcome (with videos)", Gastrointest Endosc, 69, pp.66~73 (2009)
- Schlemper RJ, "The Vienna classification of gastrointestinal epithelial neoplasia", Gut, 47, pp.251~255 (2000)
- Tanabe S, "Clinical outcome of endoscopic aspiration mucosectomy for early stage gastric cancer", Gastrointest Endosc, 56, pp.708~713 (2002)
- Soetikno RM, "Soehendra N. Endoscopic mucosal resection", Gastrointest Endosc, 57, pp.567~579 (2003)
- Ponchon T, "Endoscopic mucosal resection", J Clin Gastroenterol, 32, pp.6~10 (2001)
- Standards of Practice Committee, "The role of endoscopy in ampullary and duodenal adenomas", Gastrointest Endosc, 64, pp.849~854 (2006)
- Hurlstone DP, "A prospective evaluation of high-magnification chromoscopic colonoscopy in predicting completeness of EMR", Gastrointest Endos, 59, pp.642~650 (2004)
- Honda T, "Endoscopic submucosal dissection for superficial duodenal neoplasms", Dig Endosc, 21, pp.270~274 (2009)