Outcomes of thermal ablation of the defect margin after duodenal endoscopic mucosal resection (with videos)
| Autor: | Mayenaaz Sidhu, W. Arnout van Hattem, David J. Tate, Sergei Vosko, Jessica A. Fritzsche, Neal Shahidi, Amir Klein, Michael J. Bourke |
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| Rok vydání: | 2021 |
| Předmět: |
Adenoma
medicine.medical_specialty Endoscopic Mucosal Resection Duodenum health care facilities manpower and services Colonoscopy Endoscopic mucosal resection behavioral disciplines and activities digestive system 03 medical and health sciences 0302 clinical medicine Interquartile range health services administration medicine Humans Radiology Nuclear Medicine and imaging Prospective Studies Prospective cohort study health care economics and organizations Retrospective Studies medicine.diagnostic_test business.industry Gastroenterology Retrospective cohort study medicine.disease Surgery Clinical trial Treatment Outcome medicine.anatomical_structure 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology Neoplasm Recurrence Local business |
| Zdroj: | Gastrointestinal Endoscopy. 93:1373-1380 |
| ISSN: | 0016-5107 0230-6603 |
| DOI: | 10.1016/j.gie.2020.11.024 |
| Popis: | Background and Aims Laterally spreading lesions (LSLs) in the duodenum are conventionally treated by EMR. Recurrence is commonly encountered and can be difficult to treat safely due to the unique anatomic characteristics of the duodenum. Auxiliary techniques designed to prevent recurrence have not been described. Methods We sought to evaluate the effectiveness of thermal ablation of the defect margin after EMR (EMR-T) in reducing recurrence at first surveillance endoscopy (SE1, scheduled at 6 months) in a single tertiary referral center. All duodenal LSLs ≥10 mm referred for EMR were eligible. After successful EMR, thermal ablation was performed using snare-tip soft coagulation around the entire circumference of the resection defect. The primary outcome was the frequency of recurrence at SE1. A previous, well-characterized, prospective cohort of duodenal LSLs ≥10 mm treated by conventional EMR was the comparator. Results Over 43 months up to October 2019, 54 LSLs underwent EMR-T. One hundred twenty-five LSLs underwent conventional EMR in the comparator group. Patient and lesion characteristics were similar between the groups. Recurrence was significantly lower in the EMR-T group compared with the conventional EMR group (1 of 49 [2.3%] vs 19 of 108 [17.6%]; P = .01). No difference in technical success, EMR-related adverse outcomes, or referral to surgery were identified between the groups. Conclusions EMR-T significantly reduces the frequency of recurrence for duodenal LSLs. This technique is safe in the duodenum and has the potential to significantly improve the effectiveness of duodenal EMR. (Clinical trial registration number: NCT02306603.) |
| Databáze: | OpenAIRE |
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