Endoscopy 2021; 53(05): 522-534
DOI: 10.1055/a-1442-2395
Guideline

Endoscopic management of superficial nonampullary duodenal tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Geoffroy Vanbiervliet
 1  Department of Digestive Endoscopy, Centre Hospitalier Universitaire de Nice, Nice, France
,
Alan Moss
 2  Department of Endoscopic Services, Western Health, Melbourne, Australia
 3  Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, Victoria, Australia
,
Marianna Arvanitakis
 4  Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
,
Urban Arnelo
 5  Department of Surgery, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
,
 6  Department of Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
,
Olivier Busch
 7  Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
,
 8  Gastroenterology and Hepatology Department, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
,
 9  Department of Gastroenterology and Internal Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
10  Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
,
Alberto Larghi
11  Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
,
12  Aziende Socio Sanitaria Territoriale Rhodense, Gastroenterology, Garbagnate Milanese, Italy
,
Bertrand Napoleon
13  Service de Gastroentérologie, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France
,
Kumanan Nalankilli
 2  Department of Endoscopic Services, Western Health, Melbourne, Australia
 3  Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, Victoria, Australia
,
Manu Nayar
14  Department of Gastroenterology, Freeman Hospital, Newcastle upon Tyne, UK
,
15  Department of Gastroenterology, Georges-Pompidou European Hospital, AP-HP Centre - Université de Paris, Paris, France
,
Stefan Seewald
16  Center of Gastroenterology Centre, Klinik Hirslanden, Zurich, Switzerland
,
Marin Strijker
17  Department of Gastroenterology, Hôpital Nord, Assistance publique des hôpitaux de Marseille, Marseille, France
,
17  Department of Gastroenterology, Hôpital Nord, Assistance publique des hôpitaux de Marseille, Marseille, France
,
Jeanin E. van Hooft
18  Department of Gastroenterology and Hepatology, Leiden University Medical Center, The Netherlands
› Author Affiliations

Main recommendations

1 ESGE recommends that all duodenal adenomas should be considered for endoscopic resection as progression to invasive carcinoma is highly likely.
Strong recommendation, low quality evidence.

2 ESGE recommends performance of a colonoscopy, if that has not yet been done, in cases of duodenal adenoma.

Strong recommendation, low quality evidence.

3 ESGE recommends the use of the cap-assisted method when the location of the minor and/or major papilla and their relationship to a duodenal adenoma is not clearly established during forward-viewing endoscopy.

Strong recommendation, moderate quality evidence.

4 ESGE recommends the routine use of a side-viewing endoscope when a laterally spreading adenoma with extension to the minor and/or major papilla is suspected.

Strong recommendation, low quality evidence.

5 ESGE suggests cold snare polypectomy for small (< 6 mm in size) nonmalignant duodenal adenomas.

Weak recommendation, low quality evidence.

6 ESGE recommends endoscopic mucosal resection (EMR) as the first-line endoscopic resection technique for nonmalignant large nonampullary duodenal adenomas.
Strong recommendation, moderate quality evidence.

7 ESGE recommends that endoscopic submucosal dissection (ESD) for duodenal adenomas is an effective resection technique only in expert hands.

Strong recommendation, low quality evidence.

8 ESGE recommends using techniques that minimize adverse events such as immediate or delayed bleeding or perforation. These may include piecemeal resection, defect closure techniques, noncontact hemostasis, and other emerging techniques, and these should be considered on a case-by-case basis.

Strong recommendation, low quality evidence.

9 ESGE recommends endoscopic surveillance 3 months after the index treatment. In cases of no recurrence, a further follow-up endoscopy should be done 1 year later. Thereafter, surveillance intervals should be adapted to the lesion site, en bloc resection status, and initial histological result.

Strong recommendation, low quality evidence.



Publication History

Publication Date:
01 April 2021 (online)

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