Treatment of non-ampullary duodenal epithelial tumors: Does phenotype matter?

Although non-ampullary duodenal epithelial tumors (NADETs) are relatively rare in the general population, opportunities for endoscopic detection and treatment of them have been increasing due to advances in endoscopic equipment and awareness of the disease [1]. Because the prognosis for invasive duodenal carcinoma is dismal and surgical treatment with pancreatoduodenectomy can result in morbidity and death, less invasive prophylactic treatment of NADETs with endoscopic resection significantly benefits patients. Nevertheless, endoscopic treatment of NADETs is often difficult because the narrow and tortuous duodenal lumen restricts endoscopic maneuvers and thin duodenal walls and secretion of bile and pancreatic juice into the duodenal lumen induce severe delayed adverse events (AEs), such as bleeding and perforation [2]. Accordingly, it is important to establish practical indications for when NADETs should or should need be treated with endoscopic resection.

Publication History

Article published online:
16 August 2021

• References

• 1 Goda K, Kikuchi D, Yamamoto Y. et al. Endoscopic diagnosis of superficial non-ampullary duodenal epithelial tumors in Japan: Multicenter case series. Dig Endosc 2014; 26 (Suppl. 02) 23-29
• 2 Inoue T, Uedo N, Yamashina T. et al. Delayed perforation: a hazardous complication of endoscopic resection for non-ampullary duodenal neoplasm. Dig Endosc 2014; 26: 220-227
• 3 Kushima R, Manabe R, Hattori T. et al. Histogenesis of gastric foveolar metaplasia following duodenal ulcer: a definite reparative lineage of Brunnerʼs gland. Histopathology 1999; 35: 38-43
• 4 Ushiku T, Arnason T, Fukayama M. et al. Extra-ampullary duodenal adenocarcinoma. Am J Surg Pathol 2014; 38: 1484-1493
• 5 Kushima R, Stolte M, Dirks K. et al. Gastric-type adenocarcinoma of the duodenal second portion histogenetically associated with hyperplasia and gastric-foveolar metaplasia of Brunnerʼs glands. Virchows Arch 2002; 440: 655-659
• 6 Kushima R, Rüthlein HJ, Stolte M. et al. ‛Pyloric gland-type adenomaʼ arising in heterotopic gastric mucosa of the duodenum, with dysplastic progression of the gastric type. Virchows Arch 1999; 435: 452-457
• 7 Matsueda K, Uedo N, Kitamura M. et al. Pre-ampullary location and size ≥ 10 mm are independent predictors for high-grade superficial non-ampullary duodenal epithelial tumors. J Gastroenterol Hepatol 2020; DOI: 10.1111/jgh.15317.
• 8 Yoshida M, Shimoda T, Abe M. et al. Clinicopathological characteristics of non-ampullary duodenal tumors and their phenotypic classification. Pathol Int 2019; 69: 398-406
• 9 Matsubara A, Ogawa R, Suzuki H. et al. Activating GNAS and KRAS mutations in gastric foveolar metaplasia, gastric heterotopia, and adenocarcinoma of the duodenum. Br J Cancer 2015; 112: 1398-1404
• 10 Toba T, Inoshita N, Kaise M. et al. Clinicopathological features of superficial non-ampurally duodenal epithelial tumor; gastric phenotype of histology correlates to higher malignant potency. J Gastroenterol 2018; 53: 64-70
• 11 Minatsuki C, Yamamichi N, Inada KI. et al. Expression of gastric markers is associated with malignant potential of nonampullary duodenal adenocarcinoma. Dig Dis Sci 2018; 63: 2617-2625
• 12 Toya Y, Endo M, Yamada S. et al. The mucin phenotype does not affect the endoscopic resection outcome of non-ampullary duodenal epithelial tumors. Endosc Int Open 2021; 09: E1297-E1302
• 13 Akazawa Y, Ueyama H, Tsuyama S. et al. Endoscopic and clinicopathological features of superficial non-ampullary duodenal tumor based on the mucin phenotypes. Digestion 2020; DOI: 10.1159/000508040.
• 14 Toya Y, Endo M, Akasaka R. et al. Clinicopathological features and magnifying chromoendoscopic findings of non-ampullary duodenal epithelial tumors. Digestion 2018; 97: 219-227