Efficacy and safety of the band and slough technique for endoscopic therapy of nonampullary duodenal adenomas: a case series.

BACKGROUND: Endoscopic resection of nonampullary duodenal adenomas (NADAs) is effective but carries substantial procedural risks. Therapeutic banding for treatment of duodenal mucosal neoplasia has not been studied. We report a novel band and slough (BAS) technique for therapy of NADA without endoscopic resection.

OBJECTIVE: Efficacy and safety of BAS.

DESIGN: Retrospective review of a prospective database.

SETTING: Community hospital.

PATIENTS: Patients with sporadic and familial biopsy-proven NADA without invasive cancer undergoing BAS.

INTERVENTION: Patients were treated with BAS without endoscopic resection on an outpatient basis. A follow-up telephone call was made by a nurse at 24 hours. Follow-up endoscopy was performed at 8 weeks, with further therapy of residual NADA. In patients with minimal residual NADA not amenable to banding, argon plasma coagulation (APC) "touch-up" was used. Subsequent endoscopic surveillance was performed.

MAIN OUTCOME MEASUREMENTS: Complete histologic remission of NADA after successful BAS and postprocedure bleeding, perforation, and pain.

RESULTS: Ten patients, average age 65 years, 6 male, with sporadic/familial adenomatous polyposis NADA 8 of 2 (6 tubular adenoma and 4 tubulovillous adenoma) were treated. Mean (largest) NADA was 12.5 mm (20 mm). Five patients achieved complete remission after a single session. Among 5 patients requiring further therapy, 3 were treated with repeat banding with or without APC and 2 with APC alone. The average number of bands per session was 4.4. Patients were followed up to 24 months without NADA recurrence. None of the patients had acute or delayed adverse events of bleeding, perforation, or postprocedure pain.

LIMITATIONS: Lack of polyp tissue retrieval.

CONCLUSION: BAS appears to be a safe and potentially effective endoscopic treatment for NADA. However, larger studies are needed to corroborate these findings.