ASGE Annual Postgraduate Course: Leveraging New Advances to Improve Patient Outcomes (Live and Virtual) | May 2024-The Risky Business of Endoscopic Therapies for Duodenal Adenomas

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The document discusses the challenges and risks associated with endoscopic therapies for duodenal adenomas. The duodenum presents difficulties in scope maneuvering due to tight spaces and flexures. Factors like thin submucosal layers and presence of second-order vessels contribute to complications like bleeding and perforation during endoscopic procedures. Different methods like Cold Snare, EMR, and ESD are used for duodenal polyp resection, each with its own outcomes. Cold Snare polypectomy shows lower adverse event rates but higher recurrence in larger polyps. EMR with snare tip coagulation may reduce recurrence rates. ESD has low recurrence but high adverse events, suitable for high-risk polyps. Closure techniques post-therapy aim to reduce delayed adverse events. The comprehensive approach involves selecting the appropriate technique based on polyp size, closure of defects, and close monitoring for potential complications. In conclusion, careful planning and consideration of risks are crucial in duodenal polyp management, with different techniques offering varying outcomes to achieve successful resection while minimizing adverse events.

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Prabhleen Chahal, MD, FASGE

Keywords

endoscopic therapies

duodenal adenomas

scope maneuvering

submucosal layers

second-order vessels

bleeding

perforation

Cold Snare

EMR

ESD