The role of endoscopy in ampullary and duodenal adenomas

Chathadi, Krishnavel V.; Khashab, Mouen A.; Acosta, Ruben D.; Chandrasekhara, Vinay; Eloubeidi, Mohamad A.; Faulx, Ashley L.; Fonkalsrud, Lisa; Lightdale, Jenifer R.; Saltzman, John R.; Shaukat, Aasma; Wang, Amy; Cash, Brooks D.; DeWitt, John M.

doi:10.1016/j.gie.2015.06.027

Cited by 166 publications

(142 citation statements)

References 111 publications

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“…Early detection of DAs has been upgraded by newly introduced high-definition endoscopes, digital chromoendoscopy like narrow band imaging (NBI), and conventional dye-based chromoendoscopy [18][19][20][21]. An unimpaired examination of duodenum is achievable using a side-viewing duodenoscope and transparent distal cap attached to the gastroscope [8,20].…”

Section: Resultsmentioning

confidence: 99%

“…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]. So far, no definitive guideline has been established regarding the surveillance consensus or lesion size of ampullary adenomas for exclusive surgical removal.…”

Section: Resultsmentioning

confidence: 99%

“…The imaging role of endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound (EUS), and intraductal ultrasound can provide the assessment of intraductal extension (IDE) of the adenoma [8]. In addition, magnetic resonance cholangiopancreatography is also used to exclude IDE and pancreas divisum [29,30].…”

Section: Resultsmentioning

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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

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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“…In rare cases, the lesions, both functional and nonfunctional, may cause compression of the main pancreatic duct or bile ducts, and once the non-invasive diagnostic methods have been exhausted, endoscopic retrograde pancreatocholangiography plays an important role, especially in therapy [74,75].…”

Section: Endoscopic Diagnosticsmentioning

confidence: 99%

“…Based on individual reports in the literature, it is known that gastrinomas respond to therapy faster, but early progression is relatively frequent [6]. PRRT treatment may improve the control of hypoglycaemia in patients with malignant insulin-secreting tumours [74,148,248,249].…”

Section: Szkolenie Podyplomowementioning

confidence: 99%

Nowotwory neuroendokrynne trzustki — zasady diagnostyki i leczenia (rekomendowane przez Polską Sieć Guzów Neuroendokrynych)

Kos–Kudła¹,

Rosiek²,

Borowska³

et al. 2017

Endokrynologia Polska

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Effect of Disposable Elevator Cap Duodenoscopes on Persistent Microbial Contamination and Technical Performance of Endoscopic Retrograde Cholangiopancreatography

et al. 2023

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ImportanceInfection transmission following endoscopic retrograde cholangiopancreatography (ERCP) can occur due to persistent contamination of duodenoscopes despite high-level disinfection to completely eliminate microorganisms on the instrument.ObjectiveTo determine (1) contamination rates after high-level disinfection and (2) technical performance of duodenoscopes with disposable elevator caps compared with those with standard designs.Design, Setting, and ParticipantsIn this parallel-arm multicenter randomized clinical trial at 2 tertiary ERCP centers in Canada, all patients 18 years and older and undergoing ERCP for any indication were eligible.InterventionThe intervention was use of duodenoscopes with disposable elevator caps compared with duodenoscopes with a standard design.Main Outcomes and MeasuresCoprimary outcomes were persistent microbial contamination of the duodenoscope elevator or channel, defined as growth of at least 10 colony-forming units of any organism or any growth of gram-negative bacteria following high-level disinfection (superiority outcome), and technical success of ERCP according to a priori criteria (noninferiority outcome with an a priori noninferiority margin of 7%), assessed by blinded reviewers.ResultsFrom December 2019 to February 2022, 518 patients were enrolled (259 disposable elevator cap duodenoscopes, 259 standard duodenoscopes). Patients had a mean (SD) age of 60.7 (17.0) years and 258 (49.8%) were female. No significant differences were observed between study groups, including in ERCP difficulty. Persistent microbial contamination was detected in 11.2% (24 of 214) of standard duodenoscopes and 3.8% (8 of 208) of disposable elevator cap duodenoscopes (P = .004), corresponding to a relative risk of 0.34 (95% CI, 0.16-0.75) and number needed to treat of 13.6 (95% CI, 8.1-42.7) to avoid persistent contamination. Technical success using the disposable cap scope was noninferior to that of the standard scope (94.6% vs 90.7%, P = .13). There were no differences between study groups in adverse events and other secondary outcomes.Conclusions and RelevanceIn this randomized clinical trial, disposable elevator cap duodenoscopes exhibited reduced contamination following high-level disinfection compared with standard scope designs, without affecting the technical performance and safety of ERCP.Trial RegistrationClinicalTrials.gov Identifier: NCT04040504

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The role of endoscopy in ampullary and duodenal adenomas

Cited by 166 publications

References 111 publications

Assessment of Duodenal Adenomas and Strategies for Curative Therapy

Assessment of Duodenal Adenomas and Strategies for Curative Therapy

Nowotwory neuroendokrynne trzustki — zasady diagnostyki i leczenia (rekomendowane przez Polską Sieć Guzów Neuroendokrynych)

Effect of Disposable Elevator Cap Duodenoscopes on Persistent Microbial Contamination and Technical Performance of Endoscopic Retrograde Cholangiopancreatography

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