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Duodenal Neoplasms / Narrow Band Imaging · Journal article
Den Open · September 7, 2026
A consensus or society position rather than new primary data.
This narrative review synthesizes evidence on cold resection techniques (cold snare polypectomy, cold forceps polypectomy, and cold snare EMR) for treatment of superficial duodenal adenomas. The authors recommend cold snare polypectomy as the principal technique for selected small lesions ≤10 mm with low-grade dysplasia, while noting that management of small low-grade adenomas should be individualized with careful surveillance as an alternative to immediate resection.
Narrative review. Superficial non-ampullary duodenal epithelial tumors (SNADETs). Intervention: Cold snare polypectomy (CSP), cold forceps polypectomy (CFP), and cold snare endoscopic mucosal resection (CS-EMR). Compared with: Conventional thermal techniques (EMR, UEMR, ESD) and endoscopic surveillance without immediate resection.
In a surveillance cohort, 20.9% of low-grade dysplasia lesions progressed to high-grade dysplasia, with 4.7% eventually progressing to non-invasive carcinoma; 79.1% remained unchanged In an observational cohort of 86 SNADETs managed without immediate resection, macroscopic progression occurred in 8 cases (9.3%), with adenocarcinoma confirmed in 4 In a multicenter analysis of 3,107 patients, delayed adverse events occurred in 2.8% after EMR, 2.2% after UEMR, and 6.8% after ESD; delayed perforation occurred in 0.2% after EMR and UEMR and 2.3% after ESD
In a multicenter analysis of 3,107 patients, delayed adverse events occurred in 2.8% after EMR, 2.2% after UEMR, and 6.8% after ESD; delayed perforation occurred in 0.2% after EMR and UEMR and 2.3% after ESD Cold polypectomy (CSP and CFP combined) was associated with a delayed adverse-event rate of only 0.5% in the multicenter analysis
Clinicians should consider individualized management of small low-grade duodenal adenomas, with careful surveillance as an alternative to immediate resection. When resection is chosen, cold snare polypectomy is recommended as the principal technique for lesions ≤10 mm optically diagnosed as low-grade adenomas. The substantially lower adverse-event rates with cold techniques compared to thermal approaches support their preferential use in this high-risk anatomical location.
A narrative review synthesizing current evidence on cold resection techniques for duodenal adenomas, providing clinical recommendations for technique selection and lesion management rather than reporting original research findings.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians should consider individualized management of small low-grade duodenal adenomas, with careful surveillance as an alternative to immediate resection. When resection is chosen, cold snare polypectomy is recommended as the principal technique for lesions ≤10 mm optically diagnosed as low-grade adenomas. The substantially lower adverse-event rates with cold techniques compared to thermal approaches support their preferential use in this high-risk anatomical location.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Superficial non-ampullary duodenal epithelial tumors (SNADETs) are increasingly treated with endoscopic resection. Although conventional thermal techniques are effective, the thin duodenal wall and distinctive anatomy have driven interest in cold resection techniques that avoid electrocautery-related injury. This narrative review individually appraises cold snare polypectomy (CSP), cold forceps polypectomy (CFP), and cold snare endoscopic mucosal resection (CS-EMR) for duodenal SNADETs. Management of selected small low-grade adenomas should be individualized, with careful surveillance considered as an alternative to immediate resection. When resection is chosen, CSP is the principal cold resection technique for lesions <10 mm that are optically diagnosed as low-grade adenomas using white-light imaging and narrow-band imaging. CSP appears technically feasible and safe for selected small SNADETs. However, its shallow resection depth limits vertical margin assessment. Available follow-up data suggest low recurrence rates, and recurrent lesions are generally small and endoscopically manageable. This review also discusses the importance of pretreatment optical diagnosis, appropriate lesion selection, technical considerations, and structured surveillance after cold resection. CFP may be considered for carefully selected diminutive lesions, although the supporting evidence remains limited. Although CS-EMR can enable resection of larger lesions, substantial recurrence rates and the reported risk of perforation argue against its routine use. Overall, CSP is the principal cold resection technique for selected small low-grade adenomas, whereas CFP and CS-EMR have more limited roles.
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