Management of duodenal polyps

Assessment of Duodenal Adenomas and Strategies for Curative Therapy

“…DAs are relatively common in up to 90% of patients with familial adenomatous polyposis (FAP) and estimated in 17-25% patients with MUTYH-associated polyposis (MAP) [6,12]. The distribution of DAs in FAP, mostly found in D2, distal or adjacent to the papilla or in the duodenal cap, could be due to mucosal exposure to bile flow growth-promoting factors [13,14].…”

“…Most SDAs are flat or sessile solitary lesions with pearly villi surface and occur on the posterior or lateral walls of the descending duodenum [6,11]. The low incidence of tumor appearance in the duodenum could be explained by an interplay of protective factors as secretory immunoglobulins, small intestinal hydroxylases and higher level of benzyl peroxidase, alkaline environment, rapid transit of liquid bowel contents, and lack of bacteria [6,9].…”

“…Sporadic DAs (SDAs) are rare, with estimated prevalence of non-ampullary SDA being less than 0.5% and ampullary being between 0.04 and 0.12% [6,10]. Most SDAs are flat or sessile solitary lesions with pearly villi surface and occur on the posterior or lateral walls of the descending duodenum [6,11].…”

“…In addition to these classic adenomas, Brunner's gland adenomas and villous adenomas are also described [6][7][8][9]. Due to their malignant potential, their endoscopic or surgical resection is mandatory.…”

“…Due to their malignant potential, their endoscopic or surgical resection is mandatory. Nevertheless, anatomical features of the duodenum with thin, vascular walls, narrow luminal diameter and pancreatic and biliary drainage add to the increased complexity of endoscopic procedures [6,7,10].…”