Sporadic duodenal polyps: classification, investigation, and management

Abstract

Sporadic duodenal polyps are uncommon, being found in up to 5% of patients referred for upper gastrointestinal endoscopy. They are often discovered incidentally and are usually asymptomatic. The histological subtype of polyps cannot always be determined on endoscopic appearance alone, and biopsy is advocated. The need for further imaging, endoscopic procedures, surgical resection, and surveillance is determined by the histological features, neoplastic potential and associated symptoms. This review describes the different subtypes of sporadic duodenal polyp: adenomas, hamartomas, gastric metaplasia, inflammatory fibroids, lipomas, leiomyomas, carcinoids, stromal tumors, solitary Peutz-Jeghers polyps, lymphomas, and other rare benign and malignant lesions. It describes the epidemiology, clinical presentation, investigation, management options, and screening and surveillance strategies for each, based on current evidence.

CpG island methylator phenotype and its association with malignancy in sporadic duodenal adenomas

“…Sporadic duodenal adenomas may be amenable to endoscopic resection; however, local recurrence rates can range between 30% and 50%. 14,[32][33][34] Identification of high-risk features may aid in the stratification of recurrence risk for patients who have undergone endoscopic resection and their future surveillance. When definitive surgical resection is performed, it obviates the risk of recurrence but incurs a higher perioperative mortality and morbidity because definitive surgical resection often requires en-bloc resection of adjacent organs due to the location of the duodenum, the so-called Whipple operation.…”

Management Strategy for Small Duodenal Carcinoid Tumors: Does Conservative Management with Close Follow-Up Represent an Alternative to Endoscopic Treatment?

“…As only limited evidence is available to guide the treatment, the management strategy for small duodenal carcinoid tumors remains controversial. The ENETS guidelines recommend endoscopic treatment for carcinoid tumors ≤10 mm [7], while other experts advocate conservative management with close follow-up [19]. …”

Cap-assisted EMR of large, sporadic, nonampullary duodenal polyps

“…Data on how to perform long-term surveillance are not available; however, patient age, polyp size and histology, and technique of removal should be considered. 1,50 Because the usefulness of EUS in evaluating duodenal lesions is debated, we did not perform it in these patients. [55][56][57] Our practice is to use the morphologic characteristics of the lesions, and the absence of the lifting sign after the submucosal injection helps us to determine eligibility for EMR-C.…”