Cold versus hot EMR for large duodenal adenomas

Conventional endoscopic mucosal resection using electrocoagulation (hot EMR) for large (>20 mm), sporadic non-ampullary duodenal adenomas is associated with a high complication rate. Based on favourable colonic experience with cold EMR/ without electrocautery, we performed a retrospec- tive analysis comparing 33 patients treated this way to 101 patients who had hot EMR for their duodenal adenomas. Data were collected from four tertiary centres in two time periods. No serious adverse events (SAEs) occurred in the cold group, there were 17 intraprocedural SAEs (16.8%) and 26 postprocedural SAEs (25.7%) in the hot EMR group. Procedure time was significantly lower for cold EMR (49±25.1 min vs 96.9±56 min, p<0.01). Recurrence seen at first follow-up endoscopy was comparable in both groups (cold EMR: 4/33; 12.1% versus hot EMR: 21/101; 20.8%). This data suggests that cold EMR is a safe and feasible option for the removal of large non-ampullary duodenal adenomas.