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World J Gastrointest Endosc. Apr 16, 2023; 15(4): 248-258
Published online Apr 16, 2023. doi: 10.4253/wjge.v15.i4.248
Endoscopic resection of non-ampullary duodenal adenomas: Is cold snaring the promised land?
Ludovico Alfarone, Marco Spadaccini, Gianluca Franchellucci, Kareem Khalaf, Davide Massimi, Alessandro De Marco, Silvia Ferretti, Valeria Poletti, Antonio Facciorusso, Roberta Maselli, Alessandro Fugazza, Matteo Colombo, Antonio Capogreco, Silvia Carrara, Cesare Hassan, Alessandro Repici
Ludovico Alfarone, Marco Spadaccini, Gianluca Franchellucci, Davide Massimi, Alessandro De Marco, Silvia Ferretti, Valeria Poletti, Roberta Maselli, Cesare Hassan, Alessandro Repici, Department of Biomedical Sciences, Humanitas University, Rozzano 20089, Italy
Marco Spadaccini, Roberta Maselli, Alessandro Fugazza, Matteo Colombo, Antonio Capogreco, Silvia Carrara, Cesare Hassan, Alessandro Repici, Department of Gastroenterology, Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital, IRCCS, Rozzano 20089, Milan, Italy
Kareem Khalaf, Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto M5B 1W8, Canada
Antonio Facciorusso, Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia 71100, Italy
Author contributions: Alfarone L and Spadaccini M performed the research; Alfarone L, Franchellucci G, Khalaf K and Spadaccini M wrote the manuscript; Massimi D, De Marco A, Ferretti S, Poletti V, Facciorusso A, Maselli R, Fugazza A, Colombo M, Capogreco A, Carrara S, Hassan C and Repici A critically reviewed the content of the paper; Repici A supervised the project; All authors have read and agreed to the published version of the manuscript.
Conflict-of-interest statement: Hassan C and Repici A received a consultancy fee from Medtronic and Fujifilm. The other authors declare no competing interests related to the topic.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Marco Spadaccini, MD, Doctor, Department of Gastroenterology, Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital, IRCCS, Via Alessandro Manzoni 56, Rozzano 20089, Milan, Italy. marco.spadaccini@humanitas.it
Received: December 12, 2022
Peer-review started: December 12, 2022
First decision: February 1, 2023
Revised: February 9, 2023
Accepted: March 30, 2023
Article in press: March 30, 2023
Published online: April 16, 2023
Abstract

Due to the high risk of morbidity and mortality associated with surgical resection in this tract, endoscopic resection (ER) has taken the place of surgical resection as the first line treatment for non-ampullary duodenal adenomas. However, due to the anatomical characteristics of this area, which enhance the risk of post-ER problems, ER in the duodenum is particularly difficult. Due to a lack of data, no ER technique for superficial non-ampullary duodenal epithelial tumours (SNADETs) has yet been backed by strong, high-quality evidence; yet, traditional hot snare-based techniques are still regarded as the standard treatment. Despite having a favourable efficiency profile, adverse events during duodenal hot snare polypectomy (HSP) and hot endoscopic mucosal resection, such as delayed bleeding and perforation, have been reported to be frequent. These events are primarily caused by electrocautery-induced damage. Thus, ER techniques with a better safety profile are needed to overcome these shortcomings. Cold snare polypectomy, which has already been shown as a safer, equally effective procedure compared to HSP for treatment of small colorectal polyps, is being increasingly evaluated as a potential therapeutic option for non-ampullary duodenal adenomas. The aim of this review is to report and discuss the early outcomes of the first experiences with cold snaring for SNADETs.

Keywords: Non-ampullary duodenal adenomas, Endoscopic resection, Cold snare polypectomy, Hot snare polypectomy, Safety, Efficacy

Core Tip: A high risk of adverse events has been associated with endoscopic resection of non-ampullary duodenal adenomas. As cold snare polypectomy demonstrated a better safety profile and a similar efficacy comparing with conventional hot polypectomy in the colon, it has been increasingly considered also in the duodenum over the very last few years. Goal of this review is to summarize efficiency and safety outcomes of cold resection as a treatment for non-ampullary duodenal adenomas.