Background and aims: Data on the safety and efficacy of endoscopic resection of non-ampullary duodenal
polyps are limited. This study evaluated the safety and efficacy of endoscopic mucosal
resection (EMR) of sporadic non-ampullary duodenal polyps.
Methods: Relevant studies for the meta-analysis were identified through search of PUBMED and
EMBASE databases. Studies employing EMR for the management of sporadic duodenal polyps
in the non-ampullary region were included. The primary outcome was the surgical intervention
rates due to non-curative endoscopic resection (incomplete removal/recurrence necessitating
surgery) and/or management of procedural adverse events.
Results: A total of 440 patients (485 duodenal polyps) from 14 studies were included. The
mean size of the polyps was 13 mm to 35 mm. Surgical intervention due to non-curative
EMR and adverse events was required in 2 % (95 % confidence interval [CI] 0 – 4 %).
EMR was successfully accomplished in 93 % (95 %CI 89 – 97 %). The overall bleeding
rate after EMR was 16 % (95 %CI 10 – 23 %), and the pooled delayed bleeding rate was
5 % (95 %CI 2 – 7 %). The overall incidence of perforation was 1 % (95 %CI 1 – 3 %).
Over a median follow-up period of 6 – 72 months, the recurrence rate after EMR was
15 % (95 %CI 7 – 23 %). Six studies (pooled recurrence 20 %, 95 %CI 14 – 27 %) reported
on the outcomes of managing recurrent polyps, for which endoscopic removal was successful
in 62 % (95 %CI 37 – 87 %). There was no procedure related mortality.
Conclusion: EMR appears to be a safe and effective therapeutic option for management of sporadic
non-ampullary duodenal polyps. Long-term endoscopic surveillance is required to manage
and treat recurrent disease.
