The natural history of sporadic non‐ampullary duodenal epithelial tumors: Can we wait and see?

Sakaguchi, Yoshiki; Tsuji, Yosuke; Ushiku, Tetsuo; Kubota, Dai; Sato, Junichi; Obata, Miho; Cho, Rina; Nagao, Sayaka; Sakuma, Nobuyuki; Tamura, Naoki; Miura, Yuko; Fukagawa, Kazushi; Ohki, Daisuke; Mizutani, Hiroya; Takeuchi, Chihiro; Takahashi, Yu; Minatsuki, Chihiro; Niimi, Keiko; Yamamichi, Nobutake; Koike, Kazuhiko

doi:10.1002/deo2.9

Cited by 4 publications

(5 citation statements)

References 23 publications

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“…However, because this was a multicenter retrospective study focusing on follow-up cases, all lesions were not resected. Previous reports on the natural course of SNDA also based their final diagnoses on biopsies in nonresected lesions ( 11 – 13 ), which can be regarded as a limitation in studies observing the natural course. To mitigate this limitation, we have also shown the cumulative incidence rate of carcinoma confirmed by resection (Figure 3 ).…”

Section: Discussionmentioning

confidence: 99%

“…Cassani et al also showed that tumor atypia was exacerbated in some SNDAs ( 12 ). Sakaguchi et al ( 13 ) reported that changes in the macroscopic size or shape of SNDAs indicate a high risk of progression to invasive cancer. In those reports, the progression rate from adenoma to cancer was reported to be 4.3%–5.6% ( 11 – 13 ).…”

Section: Introductionmentioning

confidence: 99%

“…Sakaguchi et al ( 13 ) reported that changes in the macroscopic size or shape of SNDAs indicate a high risk of progression to invasive cancer. In those reports, the progression rate from adenoma to cancer was reported to be 4.3%–5.6% ( 11 – 13 ). However, most cases were low-grade adenomas (LGAs), and no reports have followed up a large number of high-grade adenomas (HGAs).…”

Section: Introductionmentioning

confidence: 99%

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Non–Pure Intestinal Phenotype as an Indicator of Progression in Sporadic Nonampullary Duodenal Adenomas: A Multicenter Retrospective Cohort Study

Uema,

Hayashi,

Komori

et al. 2023

Clin Transl Gastroenterol

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Introduction: We aimed to evaluate the natural course of sporadic non-ampullary duodenal adenomas (SNDAs) and determine the risk factors of progression. Methods: We retrospectively analyzed the follow-up outcomes of patients with biopsy-diagnosed SNDA between April 2010 and March 2016 at 13 institutions. All initial biopsy specimens were centrally evaluated. Only those diagnosed with adenomas were included. Mucinous phenotypes were classified into pure intestinal and non-pure intestinal phenotypes. Cumulative incidence rates of carcinoma and tumor enlargement were evaluated. Tumor enlargement was defined as a ≥25% or 5-mm increase in tumor size. Results: Overall, 121 lesions were analyzed. Within a median observation period of 32.7 months, five lesions were diagnosed as carcinomas; the cumulative 5-year incidence of carcinoma was 9.5%. Male sex (P=0.046), initial lesion size ≥10 mm (P=0.044), and non-pure intestinal phenotype (P=0.019) were significantly associated with progression to carcinoma. Tumor enlargement was observed in 22 lesions, with a cumulative 5-year incidence of 33.9%. Initial lesion size ≥10 mm (P<0.001), erythematous lesion (P=0.002), high-grade adenoma (P=0.002), Ki67 negative (P=0.007), and non-pure intestinal phenotype (P=0.001) were risk factors for tumor enlargement. In a multivariate analysis, an initial lesion size ≥10 mm (P=0.010) and non-pure intestinal phenotype (P=0.046) were independent and significant risk factors for tumor enlargement. Conclusions: Lesion size ≥10 mm and non-pure intestinal phenotype on initial biopsy are risk factors for cancer progression and tumor enlargement in SNDA cases. Thus, management effectiveness may be improved by focusing on lesion size and the mucinous phenotype.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Non–Pure Intestinal Phenotype as an Indicator of Progression in Sporadic Nonampullary Duodenal Adenomas: A Multicenter Retrospective Cohort Study

Uema,

Hayashi,

Komori

et al. 2023

Clin Transl Gastroenterol

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“…4 Recently, changes in size and macroscopic type have also been regarded as candidate risk factors for invasive cancer. 5 The safety and efficacy of novel new procedures for endoscopic mucosal resection (EMR), such as cold snare polypectomy 6 and underwater EMR [7][8][9] for SNADETs, have been reported. Furthermore, the availability of techniques for endoscopic submucosal dissection (ESD) of large SNADETs have also been reported.…”

Section: Introductionmentioning

confidence: 99%

“…It has been reported that 4.7% of duodenal adenomas progress to adenocarcinoma, while high‐grade dysplasia and lesions larger than 20 mm are at risk for progression to adenocaricinoma 4 . Recently, changes in size and macroscopic type have also been regarded as candidate risk factors for invasive cancer 5 …”

Section: Introductionmentioning

confidence: 99%

Current status and perspectives for endoscopic diagnosis of superficial nonampullary duodenal epithelial tumors

Toya

Endo

Sugai

et al. 2023

Digestive Endoscopy

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In recent years, there have been significant advances in the endoscopic resection (ER) procedures of superficial nonampullary duodenal epithelial tumors (SNADETs). A preoperative endoscopic diagnosis is thus deemed necessary in determining the indication for subsequent ER. For the histologic and endoscopic diagnosis of SNADETs, understanding the mucin phenotype is inevitable. Recently, two diagnostic algorithms for the differential diagnosis of SNADETs from nonneoplastic lesions under magnifying endoscopy with narrow-band imaging have been proposed. In addition, various endoscopic approaches have been proposed to differentiate low-and high-grade adenomas/carcinomas, including white light endoscopy, magnifying image-enhanced endoscopy, and endocytoscopy. These methods, however, have not been standardized with respect to the classification of their findings and the validation of their diagnostic accuracy. Moreover, there are still concerns with respect to the histologic criteria required to establish a SNADETs diagnosis. Standardization in the histologic and endoscopic diagnosis of SNADETs is needed.

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Superficial non-ampullary duodenal epithelial tumors now: endoscopic diagnosis and therapy

Hirose

Kato

Hatta

et al. 2023

Japanese Journal of Clinical Oncology

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With the recent increase in the frequency of duodenal tumor detection, significant progress has been made in endoscopic diagnosis and treatment. Although the first guidelines were issued in Japan, patient treatment varies widely among institutions. There is a need for improving the quality of endoscopic diagnosis and more curative and safer treatments. Biopsy is the standard diagnostic method; however, the diagnostic accuracy of endoscopic biopsy is not so high. Therefore, the differentiation of superficial non-ampullary duodenal epithelial tumors from non-neoplastic lesions is being developed. The incidence of lymph node and distant metastases of duodenal epithelial tumors is extremely rare in intramucosal carcinomas, and they are considered good candidates for endoscopic treatment if the technical difficulties can be resolved. Adverse events associated with endoscopic treatment are greatly reduced at advanced facilities through novel resection and closure methods, and further improvements are expected in the future. Clarifying the risk of metastatic recurrence may lead to the development of more appropriate treatments and curative resection criteria.

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The natural history of sporadic non‐ampullary duodenal epithelial tumors: Can we wait and see?

Cited by 4 publications

References 23 publications

Non–Pure Intestinal Phenotype as an Indicator of Progression in Sporadic Nonampullary Duodenal Adenomas: A Multicenter Retrospective Cohort Study

Non–Pure Intestinal Phenotype as an Indicator of Progression in Sporadic Nonampullary Duodenal Adenomas: A Multicenter Retrospective Cohort Study

Current status and perspectives for endoscopic diagnosis of superficial nonampullary duodenal epithelial tumors

Superficial non-ampullary duodenal epithelial tumors now: endoscopic diagnosis and therapy

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