Endoscopic assessment and management of sporadic duodenal adenomas: The results of single centre multidisciplinary management

Abstract

AIMTo review the role of multidisciplinary management in treating sporadic duodenal adenomas (SDA).METHODSSDA managed at North Shore Hospital between 2009-2014 were entered into a prospective database. Pathology, endoscopic and surgical management as well as follow up were reviewed.RESULTSTwenty-eight patients (14 male: Median age 68 years) presented with SDA [18 were classified as non ampullary location (NA), 10 as ampullary location (A)]. All SDA were diagnosed on upper gastrointestinal endoscopy and were imaged with a contrast enhanced CT scan of the chest, abdomen and pelvis. Of the NA adenomas 14 were located in the second part, 2 in the first part and 2 in the third part of the duodenum. Two patients declined treatment, 3 patients underwent surgical resection (2 transduodenal resections and 1 pancreaticoduodenectomy), and 23 patients were treated with endoscopic mucosal resection (EMR). The only complication with endoscopic resection was mild pancreatitis post procedure. Patients were followed with gastroduodenoscopy for a median of 22 mo (range: 2-69 mo). There were 8 recurrences treated with EMR with one patient proceeding to pancreaticodeuodenectomy because of high grade dysplasia in the resected specimen and 2 NA recurrences were managed with surgical resection (distal gastrectomy for a lesion in the first part of the duodenum and a transduodenal resection of a lesion in the third part of the duodenum).CONCLUSIONSDA can be treated endoscopically with minimal morbidity and piecemeal resection results in eradication in nearly three quarters of patients. Recurrent SDA can be treated with endoscopic reresection with surgical resection indicated when the lesions are large (> 4 cm in diameter) or demonstrate severe dysplasia or invasive cancer.

Endoscopic mucosal resection of sporadic duodenal nonampullary adenoma: outcomes of 130 patients with a long-term follow up in two tertiary French centers

“…The latest series have found good outcomes with a long follow up, 563 days for Tomizaya et al and 83 months for Valerii et al [ 11 , 19 - 22 ]. Despite these favorable results for endoscopic treatment, long-term data are still limited, with only 1 study exceeding a median follow up of 24 months [ 21 ], even though it is well known that recurrence may occur after several months or years.…”

Clinical analysis of sporadic nonampullary duodenal adenomas: multi-center retrospective study

“…There were 3 recurrences treated with 2 endoscopic resections and 1 surgery. Complications with endoscopic resection were 1 delayed bleeding and 1 pan-peritonitis, but there was no death related to the procedure 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 .…”