摘要
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.
Although uncommon, sporadic nonampullary duodenaladenomas have a growing detection due to the widespreadof endoscopy. Endoscopic therapy is being increasinglyused for these lesions, since surgery, consideredthe standard treatment, carries significant morbidityand mortality. However, the knowledge about its risksand benefits is limited, which contributes to the currentabsence of standardized recommendations. This reviewaims to discuss the efficacy and safety of endoscopicmucosal resection （EMR） and endoscopic submucosaldissection （ESD） in the treatment of these lesions. Aliterature review was performed, using the Pubmeddatabase with the query： “（duodenum or duodenal）（endoscopy or endoscopic） adenoma resection”, in thehuman species and in English. Of the 189 retrievedarticles, and after reading their abstracts, 19 wereselected due to their scientific interest. The analysisof their references, led to the inclusion of 23 morearticles for their relevance in this subject. The increaseduse of EMR in the duodenum has shown good resultswith complete resection rates exceeding 80% and lowcomplication risk （delayed bleeding in less than 12% ofthe procedures）. Although rarely used in the duodenum,ESD achieves close to 100% complete resection rates,but is associated with perforation and bleeding risk inup to one third of the cases. Even though literatureis insufficient to draw definitive conclusions, studiessuggest that EMR and ESD are valid options for thetreatment of nonampullary adenomas. Thus, strategiesto improve these techniques, and consequently increasethe effectiveness and safety of the resection of theselesions, should be developed.
