Cold snare polypectomy for duodenal adenomas in familial adenomatous polyposis: a prospective international cohort study

Arthur S Aelvoet, John G Karstensen, Barbara A J Bastiaansen, Monique E van Leerdam, Francesc Balaguer, Michal Kaminski, Roel Hompes, Patrick M M Bossuyt, Luigi Ricciardiello, Andrew Latchford, Rodrigo Jover, Maria Daca-Alvarez, Maria Pellisé, Evelien Dekker, European FAP Consortium

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Abstract

Background and study aims In patients with familial adenomatous polyposis (FAP), endoscopic resection of duodenal adenomas is commonly performed to prevent cancer and prevent or defer duodenal surgery. However, based on studies using different resection techniques, adverse events (AEs) of polypectomy in the duodenum can be significant. We hypothesized that cold snare polypectomy (CSP) is a safe technique for duodenal adenomas in FAP and evaluated its outcomes in our centers.


Patients and methods We performed a prospective international cohort study including FAP patients who underwent CSP for one or more superficial non-ampullary duodenal adenomas of any size between 2020 and 2022. At that time, this technique was common practice in our centers for superficial duodenal adenomas. The primary outcome was the occurrence of intraprocedural and post-procedural AEs.


ResultsIn total, 133 CSPs were performed in 39 patients with FAP (1–18 per session). Median adenoma size was 10 mm (interquartile range 8–15 mm), ranging from 5 to 40 mm; 27 adenomas were ≥20 mm (20%). Of the 133 polypectomies, 109 (82%) were performed after submucosal injection. Sixty-one adenomas (46%) were resected en bloc and 72 (54%) piecemeal. Macroscopic radical resection was achieved for 129 polypectomies (97%). Deep mural injury type II occurred in three polyps (2%) with no delayed perforation after prophylactic clipping. There were no clinically significant bleeds, perforations or other post-procedural AEs. Histopathology showed low-grade dysplasia in all 133 adenomas.


Conclusions CSP for (multiple) superficial non-ampullary duodenal adenomas in FAP seems feasible and safe. Long-term prospective research is needed to evaluate whether protocolized duodenal polypectomies prevent cancer and surgery.

Keywords
Familial adenomatous polyposis - Duodenal polyposis - Endoscopic resection
OriginalsprogEngelsk
TidsskriftEndoscopy International Open
Vol/bind11
Udgave nummer11
Sider (fra-til)E1056-E1062
Antal sider7
ISSN2364-3722
DOI
StatusUdgivet - 2023

Bibliografisk note

The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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