Advances in diagnostic endoscopy for duodenal, including ampullary, adenoma

Pittayanon, Rapat; Imraporn, Boonlert; Rerknimitr, Rungsun; Kullavanijaya, Pinit

doi:10.1111/den.12244

Cited by 21 publications

(15 citation statements)

References 37 publications

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“…Adenomas are the most common benign tumors arising from the ampulla even though benign neoplasms account for < 10% of all periampullary neoplasms [1]. The detection of ampullary adenomas has increased over the last years most likely due to the more abundant use of esophagogastroduodenoscopy and ultrasonography [2]. As in colorectal adenomas, ampullary adenomas can undergo malignant transformation, and therefore it is essential to completely remove the lesion [3].…”

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confidence: 99%

Endoscopic resection of advanced ampullary adenomas: a single-center 14-year retrospective cohort study

et al. 2018

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confidence: 99%

Endoscopic resection of advanced ampullary adenomas: a single-center 14-year retrospective cohort study

et al. 2018

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“…The emerging evidence for the prediction of advanced histology relies upon a variety of factors including the size of DA larger than 1 cm, the extent of involved duodenal circumference, and the relation to the ampulla of Vater [19,[22][23][24][25][26][27]. Features of submucosa invasion including a depressed component within the lesion (Paris 0-IIc), type 5 Kudo pit pattern, surface ulceration, and non-lifting sign after submucosal injection emphasize the therapeutic management of DA [22][23][24][25].…”

Section: Resultsmentioning

confidence: 99%

“…Features of submucosa invasion including a depressed component within the lesion (Paris 0-IIc), type 5 Kudo pit pattern, surface ulceration, and non-lifting sign after submucosal injection emphasize the therapeutic management of DA [22][23][24][25]. Although ampullary DAs are investigated using a sideviewing duodenoscope, biopsies for histopathological confirmation are recommended [6,27,28]. Additionally, brush cytology, polymerase chain reaction analysis of DNA for K-ras gene mutations, immunohistochemical staining (p53 tumor suppressor gene; other panels composed of CK7, CK20, CDX2, MUC1, and MUC2), microRNA expression, and flow cytometry for assessment of aneuploidy have been suggested for clinical practice but still remain investigational [8].…”

Section: Resultsmentioning

confidence: 99%

“…However, dye-based chromoendoscopy is time consuming and undependable in differentiating DAs from non-adenomas [27]. A small pilot study highlighted magnification endoscopy with NBI in differentiating adenomatous from non-adenomatous ampullary lesions based upon villi aspect as follows: type I oval-shaped indicated inflammatory or hyperplastic changes, while type 2 pinecone-shaped and type III irregular non-structured predicted adenoma and adenocarcinoma [18].…”

Section: Discussion/conclusionmentioning

confidence: 99%

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Assessment of Duodenal Adenomas and Strategies for Curative Therapy

Pavlovic-Markovic

Dragašević²,

Krstić

et al. 2019

Dig Dis

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Background: The increasing incidence of duodenal neoplasm has underlined different methods of resection depending on the clinical presentation, endoscopic features and histopathology. In this comprehensive review, we systematically describe the current knowledge concerning the diagnosis and management of duodenal adenomas (DAs) and discuss data considering all possible therapeutic approaches. Summary: Among a variety of duodenal lesions, including neuroendocrine tumors and gastrointestinal stromal tumors, DAs present precancerous lesions of the duodenal papilla or non-ampullary region necessitating removal. DAs can occur sporadically (SDA) as rare lesions or relatively common in polyposis syndromes. The endoscopic resections of DA are associated with an increased degree of complexity due to distinctive anatomical properties of the duodenal wall, luminal diameter and the presence of ampulla with pancreatic and biliary drainage. The endoscopic techniques including cold snare polypectomy (CSP), endoscopic mucosal resection (EMR), and argon plasma coagulation ablation are suggested to be less invasive than surgical treatment, associated with shorter hospital stay and lower cost. According to the current clinical practice, surgery has been accepted as standard therapeutic approach in familial adenomatous polyposis patients with severe polyposis or DA not amenable to endoscopic resection. Key Messages: The strategy for endoscopic resection of DAs depends on the lesion size, morphology, location, and histopathology findings. Small adenomas are most frequently diagnosed and removed by standard CSP techniques, while large laterally spreading lesions and ampullary adenoma are referred for EMR or endoscopic papillectomy respectively. Screening colonoscopy is indicated in patients with SDA. Additional studies for new endoscopic strategies and techniques for curative therapy of DAs are needed to refine future management decisions. Complete resection of DA is considered curative, but nevertheless, long-term endoscopic follow-up is still required to detect and treat any recurrent arising lesions.

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“…In contrast to nonampullary neoplasms, certain ampullary tumors may present early with obstructive jaundice or pancreatitis [4]. With an increas ing role of endoscopy, most premalignant lesions of the ampulla of Vater can be resolved endoscopically.…”

Section: Introductionmentioning

confidence: 99%

Surgical Treatment of Ampullary Adenocarcinoma – Single Center Experience and a Review of Literature

et al. 2018

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SummaryBackground: Adenocarcinomas of ampulla of the Vater are relatively uncommon tumors of the gastrointestinal tract. In premalignant lesions endoscopic treatment predominate. Accord ing to some authors even early adenocarcinomas (limited to mucosa) can be solved endo scopically. In malignant lesions affect ing deeper layers (includ ing submucosa) surgical ther apy is the most important. The article summarises the current view for a surgical treatment of ampullary adenocarcinomas and presents results concern ing our group of patients. Materials and Methods: In 2012-2016 a total number of 17 patients underwent resection for a tumor of ampulla of the Vater. Patients underwent standard staging, were presented before a mul tidisciplinary committee and referred to a surgical treatment. The main measured parameters were the type of surgical procedure, 30day morbidity and mortality, histopathologic result and subsequent oncologic treatment. The Leeds Pathology Protocol was used to evaluate the specimens after pancreaticoduodenectomy (PD). Results: PD (n = 9) was a more often perfor med procedure than the transduodenal surgical ampullectomy (TSA) (n = 8). TSA predomina ted in polymorbid patients. Histological results (n = 17) established adenoma with highgrade dysplasia in 4 patients, the dia gnosis of adenocarcinoma was set in 13 patients. Eight patients underwent adjuvant oncologic ther apy (2 had adjuvant chemother apy, 6 had combination of chemoradiother apy). Conclusion: Premalignant neoplasias of ampulla of the Vater can be mostly solved by endoscopy. If endoscopic resection is not possible surgical ther apy is indica ted. PD is preferred procedure in the dia gnosis of adenocarcinoma. In highrisk and polymorbid patients, with no suspicion for a metastatic lymph nodes, TSA can be considered. Endoscopic ultrasonography is the imag ing modality of choice for local stag ing of ampulla of the Vater and has important role in decid ing between endoscopic, local surgical excision (TSA) or radi cal resection (PD). Our results confirmed rightfulness to perform TSA especially in elderly or polymorbid patients, where in histopathologic specimens evaluation in TSA procedures early T stage and more favorable grad ing predominated.

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Advances in diagnostic endoscopy for duodenal, including ampullary, adenoma

Cited by 21 publications

References 37 publications

Endoscopic resection of advanced ampullary adenomas: a single-center 14-year retrospective cohort study

Endoscopic resection of advanced ampullary adenomas: a single-center 14-year retrospective cohort study

Assessment of Duodenal Adenomas and Strategies for Curative Therapy

Surgical Treatment of Ampullary Adenocarcinoma – Single Center Experience and a Review of Literature

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