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Surgical Endoscopy
Published in: Surgical Endoscopy 7/2015

01-07-2015

Prospective study of acute complication rates and associated risk factors in endoscopic therapy for duodenal adenomas

Authors: Insa Aschmoneit-Messer, Johannes Richl, Jürgen Pohl, Christian Ell, Andrea May

Published in: Surgical Endoscopy | Issue 7/2015

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Abstract

Background

Endoscopic therapy for duodenal adenomas is becoming increasingly important. However, only a few studies have been published on the topic, mainly with retrospective data.

Methods

This prospective study was carried out to determine complication rates and associated risk factors during and after endoscopic therapy for duodenal adenomas. Between May 2011 and October 2012, 50 patients (with 61 duodenal adenomas) were included. Sixty-one duodenal adenomas were resected endoscopically. Complications (e.g., bleeding, pain, fever, pancreatitis, and perforation) were recorded. Associations between bleeding and other factors—sex, age, anticoagulation, location and size of adenomas, etiology, lesion morphology, resection type, and argon plasma coagulation (APC) for bleeding prophylaxis—were then investigated.

Results

Bleeding was the main complication. Major bleeding occurred in four cases (6.5 %) and minor bleeding in 11 (18 %). One occult perforation also occurred. There was a statistically significant association between bleeding and the size of the adenoma (P = 0.012). APC for bleeding prophylaxis showed a promising trend, with an odds ratio of 0.31, reducing the bleeding risk by two-thirds in this study. However, due to the small number of six patients that received bleeding prophylaxis with APC therapy, this result was not statistically significant (P = 0.31).

Conclusions

Bleeding is the main complication in endoscopic therapy for duodenal adenomas. The bleeding risk increases significantly with adenoma size. Prophylactic APC seems to reduce the bleeding rate—however, because of the relatively small number of patients treated with APC, this partial result was not statistically relevant. Due to the relevant rate of complications, endoscopic resection of duodenal adenomas is only recommended in an in-patient setting.
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Metadata
Title
Prospective study of acute complication rates and associated risk factors in endoscopic therapy for duodenal adenomas
Authors
Insa Aschmoneit-Messer
Johannes Richl
Jürgen Pohl
Christian Ell
Andrea May
Publication date
01-07-2015
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 7/2015
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-014-3871-5

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