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Can We Decrease Lesion Recurrence After Duodenal Endoscopic Mucosal Resection?

Vanessa M. Shami, MD, FASGE, reviewing Sidhu M, et al. Gastrointest Endosc 2020 Dec 4.

Laterally spreading lesions (LSLs) of the duodenum are increasingly being diagnosed and treated endoscopically. Although endoscopic resection of the thin and vascular duodenal wall is technically challenging, endoscopic mucosal resection (EMR) is easier than endoscopic submucosal dissection at the expense of increased recurrence. This prospectively collected, single-center, observational study assessed whether thermal ablative therapy at the resection margins after EMR (EMR-T) reduces recurrence at the first 6-month surveillance endoscopy. 

Fifty-four patients with duodenal LSLs >10 mm were consecutively enrolled in the EMR-T group over 43 months (March 2016-October 2019). Snare-tip soft-coagulation (effect 4, 80 watts; ERBE, Tübingen, Germany) was utilized around the circumference of the EMR defect. The aim was to create a 2-mm to 3-mm rim of completely ablated tissue. The EMR-T cohort was compared with a historic cohort of 125 LSLs treated by conventional EMR before March 2016. Recurrence was significantly lower in the EMR-T group versus the conventional EMR group (1/49 [2.3%] vs 19/108 [17.6%]; P=.01). Additionally, there were no differences in technical success, adverse events, or need to refer to surgery.

Vanessa M. Shami, MD, FASGE

COMMENT

Duodenal LSL resections are technically challenging yet rewarding if handled appropriately. Since therapy of recurrent lesions can be a bear, the endoscopist should do everything possible to reduce this scenario. Outcome studies such as this demonstrate the importance of taking the extra time to ablate the edges of the defect.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Sidhu M, Fritzsche JA, Klein A, et al. Outcomes of thermal ablation of the defect margin after duodenal endoscopic mucosal resection (with videos). Gastrointest Endosc 2020 Dec 4. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2020.11.024)

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