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.
