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.

Aziende Socio Sanitaria Territoriale Rhodense Gastroenterology Garbagnate Milanese Italy

Center of Gastroenterology Centre Klinik Hirslanden Zurich Switzerland

Department of Digestive Endoscopy Centre Hospitalier Universitaire de Nice Nice France

Department of Endoscopic Services Western Health Melbourne Australia

Department of Gastroenterology and Hepatology Leiden University Medical Center The Netherlands

Department of Gastroenterology and Internal Medicine University Hospital Brno Faculty of Medicine Masaryk University Brno Czech Republic

Department of Gastroenterology Evangelisches Krankenhaus Düsseldorf Düsseldorf Nordrhein Westfalen Germany

Department of Gastroenterology Freeman Hospital Newcastle upon Tyne UK

Department of Gastroenterology Georges Pompidou European Hospital AP HP Centre Université de Paris Paris France

Department of Gastroenterology Hôpital Nord Assistance publique des hôpitaux de Marseille Marseille France

Department of Medicine Western Health Melbourne Medical School The University of Melbourne Victoria Australia

Department of Surgery Cancer Center Amsterdam Amsterdam UMC University of Amsterdam Amsterdam The Netherlands

Department of Surgery Centre for Digestive Diseases Karolinska University Hospital Stockholm Sweden

Department of Surgery University Hospital Brno Faculty of Medicine Masaryk University Brno Czech Republic

Digestive Endoscopy Unit Fondazione Policlinico Universitario A Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy

Gastroenterology and Hepatology Department Cliniques universitaires Saint Luc Université Catholique de Louvain Brussels Belgium

Gastroenterology Hepatopancreatology and Digestive Oncology Erasme Hospital Université Libre de Bruxelles Brussels Belgium

Service de Gastroentérologie Hôpital Privé Jean Mermoz Ramsay Générale de Santé Lyon France

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