Efficacy and safety of endoscopic mucosal resection of non-ampullary duodenal polyps: a systematic review

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 13mm to 35mm. 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. Longterm endoscopic surveillance is required to manage and treat recurrent disease.