CLINICAL IMPACT OF ENDOSCOPIC RESECTION USING BIPOLAR SNARE FOR NON-AMPULLARY DUODENAL TUMOR

Aims:

The aim of this study was to evaluate the safety and usefulness of endoscopic resection using bipolar snare for duodenal tumor compared to monopolar snare.

Methods:

A total of 209 patients with 320 non-ampullary duodenal tumors underwent endoscopic mucosal resection (EMR), or polypectomy between 2000 and 2017. Patients/lesions were divided into 2 groups based on the snare type of monopolar (Group M) or bipolar (Group B), and clinical outcomes were analyzed.

Results:

Group M included 148 patients with 162 lesions (male/female/mean age, 103/45/62.6), while 61 patients having 156 lesions (41/20/55.6) were involved in Group B. Familial adenomatous polyposis patients were 11 patients with 17 lesions and 20 patients with 110 lesions in Group M and B.

Lesion locations (1st/2nd/3 rd/anastomosis) and macroscopic types (elevated/depressed/combined) were 23/121/15/3 and 125/22/15 in Group M, and 19/121/16/0 and 117/32/7 in Group B, respectively.

EMR/polypectomy was performed for 154/8 lesions and 102/54 lesions in Group M and B. En-bloc resection rates for Group M/B were 65% (105/162)/80% (125/156) (p < 0.001), and the mean number of resected lesions were 1.1 (M)/2.2 (B) (P < 0.0001).

The median tumor sizes in Group M/B were 12 mm (range 3 – 50)/10 mm (3 – 40) (P < 0.0001).

Prophylactic immediate closure was performed for 143 lesions (88%) and 95 (60%) in Group M and B (p < 0.001). The median tumor size with/without closure was 10 mm (4 – 40)/8 mm (3 – 22) in group M/B (P < 0.0001). The rate of delayed bleeding was 9.8% (16/162) and 0.6% (1/156) in Group M and B (P < 0.0002), with/without closure 9% (13/143)/16% (3/19) for M, 1% (1/195)/0% (0/61) for B, respectively.

Conclusions:

Group B can be safely performed with a low incidence of delayed bleeding compared to Group M. In case of small lesions, it is not always required immediate closure after bipolar snaring for preventing delayed bleeding.