Hybrid Resection versus Conventional Resection for Laterally Spreading Lesions of the Papilla.

Papillectomy adenoma duodenum

Journal

Gastrointestinal endoscopy
ISSN: 1097-6779
Titre abrégé: Gastrointest Endosc
Pays: United States
ID NLM: 0010505

Informations de publication

Date de publication:
17 Oct 2023
Historique:
received: 22 02 2023
revised: 06 09 2023
accepted: 10 10 2023
medline: 20 10 2023
pubmed: 20 10 2023
entrez: 20 10 2023
Statut: aheadofprint

Résumé

Conventional hot-snare resection (CR) of laterally spreading papillary adenomas (LSL-P) is effective, however can be associated with delayed bleeding (DB) in upwards of 25% of cases. Given the excellent safety-profile of the cold-snare polypectomy in the colorectum, we investigated the efficacy and safety of a novel hybrid hot-snare plus cold-snare resection (HR) technique for LSL-P management. A prospective cohort of patients underwent HR in a tertiary referral center over 60 months until December 2022. This was compared to a historical cohort of patients that underwent CR at the same institution over 120 months until August 2017. The primary outcomes were recurrence and bleeding. 20 patients underwent HR (14 female, mean age 65.2±12.2 years). Median lesion size was 30 mm (IQR 25.0-47.5mm). Recurrent or residual adenoma (RRA) was greater with HR (n=10, 58.8% vs. n=14, 29.8%, P=0.034). The odds ratio for recurrence was 3.6 times (95%CI 1.2-11.0) higher with HR (P=0.027). RRA was multi-focal in 4 (40%) and had a composite RRA volume of >10 mm in 7 (70%). The median number of procedures required to treat RRA was higher with HR (4 vs. 1, P=0.002). There was no difference between CR and HR for intraprocedural bleeding (n=23, 41.1% vs. n=5, 25%, P=0.587) or DB (25.0% vs. 10.0%, P=0.211). There were no perforations. The novel hybrid resection technique for LSL-P management is associated with a high rate of RRA that is recalcitrant to treatment, without mitigating the risk of intraprocedural or delayed bleeding. Therefore, conventional hot-snare resection should remain the mainstay management option for treating patients with an LSL-P.

Sections du résumé

BACKGROUND AND AIMS OBJECTIVE
Conventional hot-snare resection (CR) of laterally spreading papillary adenomas (LSL-P) is effective, however can be associated with delayed bleeding (DB) in upwards of 25% of cases. Given the excellent safety-profile of the cold-snare polypectomy in the colorectum, we investigated the efficacy and safety of a novel hybrid hot-snare plus cold-snare resection (HR) technique for LSL-P management.
METHODS METHODS
A prospective cohort of patients underwent HR in a tertiary referral center over 60 months until December 2022. This was compared to a historical cohort of patients that underwent CR at the same institution over 120 months until August 2017. The primary outcomes were recurrence and bleeding.
RESULTS RESULTS
20 patients underwent HR (14 female, mean age 65.2±12.2 years). Median lesion size was 30 mm (IQR 25.0-47.5mm). Recurrent or residual adenoma (RRA) was greater with HR (n=10, 58.8% vs. n=14, 29.8%, P=0.034). The odds ratio for recurrence was 3.6 times (95%CI 1.2-11.0) higher with HR (P=0.027). RRA was multi-focal in 4 (40%) and had a composite RRA volume of >10 mm in 7 (70%). The median number of procedures required to treat RRA was higher with HR (4 vs. 1, P=0.002). There was no difference between CR and HR for intraprocedural bleeding (n=23, 41.1% vs. n=5, 25%, P=0.587) or DB (25.0% vs. 10.0%, P=0.211). There were no perforations.
CONCLUSIONS CONCLUSIONS
The novel hybrid resection technique for LSL-P management is associated with a high rate of RRA that is recalcitrant to treatment, without mitigating the risk of intraprocedural or delayed bleeding. Therefore, conventional hot-snare resection should remain the mainstay management option for treating patients with an LSL-P.

Identifiants

DOI: 10.1016/j.gie.2023.10.034 PMID: 37858758
pubmed: 37858758
pii: S0016-5107(23)02974-7
doi: 10.1016/j.gie.2023.10.034
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2023 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Auteurs

Sunil Gupta (S)

Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, NSW, Australia;; Westmead Clinical School, University of Sydney, Sydney, NSW, Australia.

Ana Craciun (A)

Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, NSW, Australia;; Departamento de Gastrenterologia e Hepatologia, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.

Hunter Wang (H)

Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, NSW, Australia;; Westmead Clinical School, University of Sydney, Sydney, NSW, Australia.

Anthony Whitfield (A)

Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, NSW, Australia;; Westmead Clinical School, University of Sydney, Sydney, NSW, Australia.

Julia Gauci (J)

Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, NSW, Australia.

Timothy O'Sullivan (T)

Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, NSW, Australia;; Westmead Clinical School, University of Sydney, Sydney, NSW, Australia.

Oliver Cronin (O)

Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, NSW, Australia;; Westmead Clinical School, University of Sydney, Sydney, NSW, Australia.

Muhammad Abu Arisha (MA)

Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, NSW, Australia.

Amir Klein (A)

Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, NSW, Australia.

Eric Y T Lee (EYT)

Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, NSW, Australia.

Nicholas G Burgess (NG)

Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, NSW, Australia;; Westmead Clinical School, University of Sydney, Sydney, NSW, Australia.

Michael J Bourke (MJ)

Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, NSW, Australia;; Westmead Clinical School, University of Sydney, Sydney, NSW, Australia;. Electronic address: michael@citywestgastro.com.au.

Classifications MeSH