Subscribe to RSS
Please copy the URL and add it into your RSS Feed Reader.
https://www.thieme-connect.de/rss/thieme/en/10.1055-s-00025476.xml
Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(01): E96-E108
DOI: 10.1055/a-1723-2847
DOI: 10.1055/a-1723-2847
Review
Endoscopic management of non-ampullary duodenal adenomas
Abstract
Duodenal polyps are found in 0.1 % to 0.8 % of all upper endoscopies. Duodenal adenomas account for 10 % to 20 % of these lesions. They can be sporadic or occur in the setting of a hereditary predisposition syndrome, mainly familial adenomatous polyposis. Endoscopy is the cornerstone of management of duodenal adenomas, allowing for diagnosis and treatment, primarily by endoscopic mucosal resection. The endoscopic treatment of duodenal adenomas has a high morbidity, reaching 15 % in a prospective study, consisting of bleeding and perforations, and should therefore be performed in expert centers. The local recurrence rate ranges from 9 % to 37 %, and is maximal for piecemeal resections of lesions > 20 mm. Surgical resection of the duodenum is flawed with major morbidity and considered a rescue procedure in cases of endoscopic treatment failures or severe endoscopic complications such as duodenal perforations. In this paper, we review the existing evidence on endoscopic diagnosis and treatment of non-ampullary duodenal adenomas.
Publication History
Received: 04 May 2021
Accepted after revision: 19 October 2021
Article published online:
14 January 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Höchter W, Weingart J, Seib H-J. et al. Duodenalpolypen: Häufigkeit, histologisches Substrat und Bedeutung. DMW – Dtsch Med Wochenschr 2008; 109: 1183-1186
- 2 Dixon MF. Gastrointestinal epithelial neoplasia: Vienna revisited. Gut 2002; 51: 130-131
- 3 Okada K, Fujisaki J, Kasuga A. et al. Sporadic Nonampullary duodenal adenoma in the natural history of duodenal cancer: a study of follow-up surveillance. Am J Gastroenterol 2011; 106: 357-364
- 4 Wagner PL, Chen Y-T, Yantiss RK. Immunohistochemical and molecular features of sporadic and FAP-associated duodenal adenomas of the ampullary and nonampullary mucosa. Am J Surg Pathol 2008; 32: 1388-1395
- 5 Rubio CA, Kaufeldt A, Kohan R. et al. β-catenin Helices in the Cytoplasm of sporadic and FAP duodenal adenomas. Anticancer Res 2015; 35: 1433-1436
- 6 Niwa A, Kuwano S, Tomita H. et al. The different pathogenesis of sporadic adenoma and adenocarcinoma in non-ampullary lesions of the proximal and distal duodenum. Oncotarget 2017; http://www.oncotarget.com/fulltext/17051
- 7 Hida R, Yamamoto H, Hirahashi M. et al. Duodenal neoplasms of gastric phenotype: an immunohistochemical and genetic study with a practical approach to the classification. Am J Surg Pathol 2017; 41: 343-353
- 8 Ushiku T, Arnason T, Fukayama M. et al. Extra-ampullary duodenal adenocarcinoma. Am J Surg Pathol 2014; 38: 1484-1493
- 9 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
- 10 Ghazi A. Endoscopic Gastroduodenal polypectomy. Ann Surg 1984; 200: 175-180
- 11 Jung SH, Chung WC, Kim EJ. et al. Evaluation of non-ampullary duodenal polyps: comparison of non-neoplastic and neoplastic lesions. World J Gastroenterol 2010; 16: 5474-5480
- 12 Jepsen JM, Persson M, Jakobsen NO. et al. Prospective study of prevalence and endoscopic and histopathologic characteristics of duodenal polyps in patients submitted to upper endoscopy. Scand J Gastroenterol 1994; 29: 483-487
- 13 Ross R, Hartnett N, Bernstein L. et al. Epidemiology of adenocarcinomas of the small intestine: is bile a small bowel carcinogen?. Br J Cancer 1991; 63: 143-145
- 14 Yoshida M, Yabuuchi Y, Kakushima N. et al. The incidence of non‐ampullary duodenal cancer in Japan: The first analysis of a national cancer registry. J Gastroenterol Hepatol 2021; 36: 1216-1221
- 15 Apel D, Jakobs R, Weickert U. et al. High frequency of colorectal adenoma in patients with duodenal adenoma but without familial adenomatous polyposis. Gastrointest Endosc 2004; 60: 397-399
- 16 Murray MA. Sporadic duodenal adenoma is associated with colorectal neoplasia. Gut 2004; 53: 261-265
- 17 Wu Z-J, Lin Y, Xiao J. et al. Clinical Significance of colonoscopy in patients with upper gastrointestinal polyps and neoplasms: a meta-analysis. PLoS ONE 2014; 9: e91810
- 18 Chathadi KV, Khashab MA, Acosta RD. et al. The role of endoscopy in ampullary and duodenal adenomas. Gastrointest Endosc 2015; 82: 773-781
- 19 Riemann JF, Hartmann D, Schilling D. et al. Frequency of small bowel polyps in patients with duodenal adenoma but without familial adenomatous polyposis. Z Für Gastroenterol 2006; 44: 235-238
- 20 Johnson MD, Mackey R, Brown N. et al. Outcome based on management for duodenal adenomas: sporadic versus familial disease. J Gastrointest Surg 2010; 14: 229-235
- 21 Bülow S. Duodenal adenomatosis in familial adenomatous polyposis. Gut 2004; 53: 381-386
- 22 Bülow S, Christensen IJ, Højen H. et al. Duodenal surveillance improves the prognosis after duodenal cancer in familial adenomatous polyposis: Duodenal surveillance improves the prognosis after duodenal cancer. Colorectal Dis 2012; 14: 947-952
- 23 Spigelman AD, Talbot IC, Williams CB. et al. Upper gastrointestinal cancer in patients with familial adenomatous polyposis. Lancet 1989; 334: 783-785
- 24 Sourrouille I, Lefèvre JH, Shields C. et al. Surveillance of Duodenal polyposis in familial adenomatous polyposis: should the Spigelman score be modified?. Dis Colon Rectum 2017; 60: 1137-1146
- 25 Latchford AR, Neale KF, Spigelman AD. et al. Features of Duodenal cancer in patients with familial adenomatous polyposis. Clin Gastroenterol Hepatol 2009; 7: 659-663
- 26 Groves CJ. Duodenal cancer in patients with familial adenomatous polyposis (FAP): results of a 10 year prospective study. Gut 2002; 50: 636-641
- 27 Thiruvengadam SS, Lopez R, O’Malley M. et al. Spigelman stage IV duodenal polyposis does not precede most duodenal cancer cases in patients with familial adenomatous polyposis. Gastrointest Endosc 2019; 89: 345-354.e2
- 28 Saurin J-C, Gutknecht C, Napoleon B. et al. Surveillance of duodenal adenomas in familial adenomatous polyposis reveals high cumulative risk of advanced disease. J Clin Oncol 2004; 22: 493-498
- 29 Lepilliez V, Napoleon B, Lepilliez V. et al. Endoscopic treatment of severe duodenal polyposis as an alternative to surgery for patients with familial adenomatous polyposis. Gastrointest Endosc 2014; 80: 817-825
- 30 Roos VH, Bastiaansen BA, Kallenberg FGJ. et al. Endoscopic management of duodenal adenomas in patients with familial adenomatous polyposis. Gastrointest Endosc 2020; S0016510720344230
- 31 van Leerdam ME, Roos VH, van Hooft JE. et al. Endoscopic management of polyposis syndromes: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2019; 51: 877-895
- 32 Bonadona V. Cancer risks associated with germline mutations in MLH1, MSH2, and MSH6 genes in Lynch syndrome. JAMA 2011; 305: 2304
- 33 Giardiello FM, Allen JI, Axilbund JE. et al. Guidelines on Genetic evaluation and management of Lynch Syndrome: a consensus statement by the US Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol 2014; 109: 1159-1179
- 34 Vasen HFA, Blanco I, Aktan-Collan K. et al. Revised guidelines for the clinical management of Lynch syndrome (HNPCC): recommendations by a group of European experts 12.
- 35 Schulmann K, Brasch FE, Kunstmann E. et al. HNPCC-associated small bowel cancer: Clinical and molecular characteristics. Gastroenterology 2005; 128: 590-599
- 36 Hammoudi N, Dhooge M, Coriat R. et al. Duodenal tumor risk in Lynch syndrome. Dig Liver Dis 2019; 51: 299-303
- 37 Saurin J-C, Pilleul F, Soussan E. et al. Small-bowel capsule endoscopy diagnoses early and advanced neoplasms in asymptomatic patients with Lynch syndrome. Endoscopy 2010; 42: 1057-1062
- 38 Haanstra JF, Al-Toma A, Dekker E. et al. Prevalence of small-bowel neoplasia in Lynch syndrome assessed by video capsule endoscopy. Gut 2015; 64: 1578-1583
- 39 Vogt S, Jones N, Christian D. et al. Expanded extracolonic tumor spectrum in MUTYH-associated polyposis. Gastroenterology 2009; 137: 1976-1985.e10
- 40 Rayner E, van Gool IC, Palles C. et al. A panoply of errors: polymerase proofreading domain mutations in cancer. Nat Rev Cancer 2016; 16: 71-81
- 41 Hamzaoui N, Alarcon F, Leulliot N. et al. Genetic, structural, and functional characterization of POLE polymerase proofreading variants allows cancer risk prediction. Genet Med 2020; 22: 1533-1541
- 42 Probst A, Freund S, Neuhaus L. et al. Complication risk despite preventive endoscopic measures in patients undergoing endoscopic mucosal resection of large duodenal adenomas. Endoscopy 2020;
- 43 Tomizawa Y, Ginsberg GG. Clinical outcome of EMR of sporadic, nonampullary, duodenal adenomas: a 10-year retrospective. Gastrointest Endosc 2018; 87: 1270-1278
- 44 Hara Y, Goda K, Dobashi A. et al. Short- and long-term outcomes of endoscopically treated superficial non-ampullary duodenal epithelial tumors. World J Gastroenterol 2019; 25: 707-718
- 45 Goda K, Kikuchi D, Yamamoto Y. et al. Endoscopic diagnosis of superficial non-ampullary duodenal epithelial tumors in Japan: Multicenter case series: Superficial non-ampullary duodenal tumors. Dig Endosc 2014; 26: 23-29
- 46 Kakushima N. Endoscopic and biopsy diagnoses of superficial, nonampullary, duodenal adenocarcinomas. World J Gastroenterol 2015; 21: 5560
- 47 Sellner F. Investigations on the significance of the adenoma-carcinoma sequence in the small bowel. Cancer 1990; 66: 702-715
- 48 Valerii G, Tringali A, Landi R. et al. Endoscopic mucosal resection of non-ampullary sporadic duodenal adenomas: a retrospective analysis with long-term follow-up. Scand J Gastroenterol 2018; 53: 490-494
- 49 Kallenberg F, Bastiaansen B, Dekker E. Cap-assisted forward-viewing endoscopy to visualize the ampulla of Vater and the duodenum in patients with familial adenomatous polyposis. Endoscopy 2016; 49: 181-185
- 50 Dekker E, Boparai K, Poley J. et al. High resolution endoscopy and the additional value of chromoendoscopy in the evaluation of duodenal adenomatosis in patients with familial adenomatous polyposis. Endoscopy 2009; 41: 666-669
- 51 Kiesslich R, Mergener K, Naumann C. et al. Value of chromoendoscopy and magnification endoscopy in the evaluation of duodenal abnormalities: a prospective, randomized comparison. Endoscopy 2003; 35: 559-563
- 52 Hurley JJ, Thomas LE, Walton S-J. et al. The impact of chromoendoscopy for surveillance of the duodenum in patients with MUTYH-associated polyposis and familial adenomatous polyposis. Gastrointest Endosc 2018; 88: 665-673
- 53 Blackman E, Nash SV. Diagnosis of duodenal and ampullary epithelial neoplasms by endoscopic biopsy: A clinicopathologic and immunohistochemical study. Hum Pathol 1985; 16: 901-910
- 54 Kinoshita S, Nishizawa T, Ochiai Y. et al. Accuracy of biopsy for the preoperative diagnosis of superficial nonampullary duodenal adenocarcinoma. Gastrointest Endosc 2017; 86: 329-332
- 55 Kakushima N, Yoshida M, Yamaguchi Y. et al. Magnified endoscopy with narrow-band imaging for the differential diagnosis of superficial non-ampullary duodenal epithelial tumors. Scand J Gastroenterol 2019; 54: 128-134
- 56 Yoshimura N, Goda K, Tajiri H. et al. Endoscopic features of nonampullary duodenal tumors with narrow-band imaging. Hepatogastroenterol 2010; 57: 462-467
- 57 Kikuchi D, Hoteya S, Iizuka T. et al. Diagnostic algorithm of magnifying endoscopy with narrow band imaging for superficial non-ampullary duodenal epithelial tumors. Dig Endosc 2014; 26: 16-22
- 58 Yao K, Iwashita A, Tanabe H. et al. White opaque substance within superficial elevated gastric neoplasia as visualized by magnification endoscopy with narrow-band imaging: a new optical sign for differentiating between adenoma and carcinoma. Gastrointest Endosc 2008; 68: 574-580
- 59 Yao K, Iwashita A, Nambu M. et al. Nature of white opaque substance in gastric epithelial neoplasia as visualized by magnifying endoscopy with narrow-band imaging. Dig Endosc 2012; 24: 419-425
- 60 Yamasaki Y, Takeuchi Y, Kanesaka T. et al. Differentiation between duodenal neoplasms and non‐neoplasms using magnifying narrow‐band imaging - Do we still need biopsies for duodenal lesions?. Dig Endosc 2020; 32: 84-95
- 61 Kakushima N, Yoshida M, Iwai T. et al. A simple endoscopic scoring system to differentiate between duodenal adenoma and carcinoma. Endosc Int Open 2017; 5: E763-E768
- 62 Azih LC. Endoscopic ultrasound evaluation in the surgical treatment of duodenal and peri-ampullary adenomas. World J Gastroenterol 2013; 19: 511
- 63 Barat M, Dohan A, Dautry R. et al. Mass-forming lesions of the duodenum: A pictorial review. Diagn Interv Imaging 2017; 98: 663-675
- 64 Vanbiervliet G, Moss A, Arvanitakis M. et al. Endoscopic management of superficial nonampullary duodenal tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021; 53: 522-534
- 65 Hamada K, Takeuchi Y, Ishikawa H. et al. Feasibility of cold snare polypectomy for multiple duodenal adenomas in patients with familial adenomatous polyposis: a pilot study. Dig Dis Sci 2016; 61: 2755-2759
- 66 Hamada K, Takeuchi Y, Ishikawa H. et al. Safety of cold snare polypectomy for duodenal adenomas in familial adenomatous polyposis: a prospective exploratory study. Endoscopy 2018; 50: 511-517
- 67 Patel N, Ponugoti P, Rex D. Cold snare polypectomy effectively reduces polyp burden in familial adenomatous polyposis. Endosc Int Open 2016; 04: E472-E474
- 68 Maruoka D, Matsumura T, Kasamatsu S. et al. Cold polypectomy for duodenal adenomas: a prospective clinical trial. Endoscopy 2017; 49: 776-783
- 69 Jamil LH, Kashani A, Peter N. et al. Safety and efficacy of cap-assisted EMR for sporadic nonampullary duodenal adenomas. Gastrointest Endosc 2017; 86: 666-672
- 70 Conio M, De Ceglie A, Filiberti R. et al. Cap-assisted EMR of large, sporadic, nonampullary duodenal polyps. Gastrointest Endosc 2012; 76: 1160-1169
- 71 Valli PV, Mertens JC, Sonnenberg A. et al. Nonampullary duodenal adenomas rarely recur after complete endoscopic resection: a Swiss experience including a literature review. Digestion 2017; 96: 149-157
- 72 Bartel MJ, Puri R, Brahmbhatt B. et al. Endoscopic and surgical management of nonampullary duodenal neoplasms. Surg Endosc 2018; 32: 2859-2869
- 73 Abbass R, Rigaux J, Al-Kawas FH. Nonampullary duodenal polyps: characteristics and endoscopic management. Gastrointest Endosc 2010; 71: 754-759
- 74 Lépilliez V, Chemaly M, Ponchon T. et al. Endoscopic resection of sporadic duodenal adenomas: an efficient technique with a substantial risk of delayed bleeding. Endoscopy 2008; 40: 806-810
- 75 Apel D, Jakobs R, Spiethoff A. et al. Follow-Up after Endoscopic Snare Resection of Duodenal Adenomas. Endoscopy 2005; 37: 444-448
- 76 Nonaka S, Oda I, Tada K. et al. Clinical outcome of endoscopic resection for nonampullary duodenal tumors. Endoscopy 2014; 47: 129-135
- 77 Aschmoneit-Messer I, Richl J, Pohl J. et al. Prospective study of acute complication rates and associated risk factors in endoscopic therapy for duodenal adenomas. Surg Endosc 2015; 29: 1823-1830
- 78 Chung J, Wang K, Podboy A. et al. Endoscopic suturing for the prevention and treatment of complications associated with endoscopic mucosal resection of large duodenal adenomas. Clin Endosc 2021;
- 79 Yamasaki Y, Uedo N, Takeuchi Y. et al. Underwater endoscopic mucosal resection for superficial nonampullary duodenal adenomas. Endoscopy 2017;
- 80 Binmoeller KF, Shah JN, Bhat YM. et al. “Underwater” EMR of sporadic laterally spreading nonampullary duodenal adenomas (with video). Gastrointest Endosc 2013; 78: 496-502.e1
- 81 Shibukawa G, Irisawa A, Sato A. et al. Endoscopic mucosal resection performed underwater for nonampullary duodenal epithelial tumor: evaluation of feasibility and safety. Gastroenterol Res Pract 2018; 2018: 1-10
- 82 Kiguchi Y, Kato M, Nakayama A. et al. Feasibility study comparing underwater endoscopic mucosal resection and conventional endoscopic mucosal resection for superficial non‐ampullary duodenal epithelial tumor < 20 mm. Dig Endosc 2020; 32: 753-760
- 83 Yamamoto H. Successful en-bloc resection of large superficial tumors in the stomach and colon using sodium hyaluronate and small-caliber-tip transparent hood. Endoscopy 2003; 35: 690-694
- 84 Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T. et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47: 829-854
- 85 Yahagi N, Kato M, Ochiai Y. et al. Outcomes of endoscopic resection for superficial duodenal epithelial neoplasia. Gastrointest Endosc 2018; 88: 676-682
- 86 Lienert A, Bagshaw PF. Treatment of duodenal adenomas with endoscopic argon plasma coagulation. ANZ J Surg 2007; 77: 371-373
- 87 Min YW, Min B-H, Kim ER. et al. Efficacy and safety of endoscopic treatment for nonampullary sporadic duodenal adenomas. Dig Dis Sci 2013; 58: 2926-2932
- 88 Al-Sarireh B, Ghaneh P, Gardner-Thorpe J. et al. Complications and follow-up after pancreas-preserving total duodenectomy for duodenal polyps. Br J Surg 2008; 95: 1506-1511
- 89 Yan J-Q, Peng C-H, Yang W-P. et al. Surgical management of benign duodenal tumours. ANZ J Surg 2010; 80: 526-530
- 90 Kokosis G, Ceppa EP, Tyler DS. et al. Laparoscopic Duodenectomy for Benign Nonampullary Duodenal Neoplasms. Surg Laparosc Endosc Percutan Tech 2015; 25: 158-162
- 91 Abe N, Suzuki Y, Masaki T. et al. Surgical management of superficial non-ampullary duodenal tumors. Dig Endosc Off J Jpn Gastroenterol Endosc Soc 2014; 26: 57-63
- 92 Debinski HS. Effect of sulindac on small polyps in familial adenomatous polyposis. Lancet 1995; 345: 855-856
- 93 Seow-Choen F, Vijayan V, Keng V. Prospective randomized study of sulindacversus calcium and calciferol for upper gastrointestinal polyps in familial adenomatous polyposis. Br J Surg 1996; 83: 1763-1766
- 94 Samadder NJ, Neklason DW, Boucher KM. et al. Effect of Sulindac and erlotinib vs placebo on duodenal neoplasia in familial adenomatous polyposis: a randomized clinical trial. JAMA 2016; 315: 1266
- 95 Phillips RKS. A randomised, double blind, placebo controlled study of celecoxib, a selective cyclooxygenase 2 inhibitor, on duodenal polyposis in familial adenomatous polyposis. Gut 2002; 50: 857-860
- 96 Parc Y, Desaint B, Fléjou J-F. et al. The effect of ursodesoxycholic acid on duodenal adenomas in familial adenomatous polyposis: a prospective randomized placebo-control trial: Ursodesoxycholic acid in FAP patients. Colorectal Dis 2012; 14: 854-860
- 97 van Heumen BW, Roelofs HM, Vink-Börger M. et al. Ursodeoxycholic acid counteracts celecoxib in reduction of duodenal polyps in patients with familial adenomatous polyposis: a multicentre, randomized controlled trial. Orphanet J Rare Dis 2013; 8: 118
- 98 Yang J, Gurudu SR, Koptiuch C. et al. American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in familial adenomatous polyposis syndromes. Gastrointest Endosc 2020; 91: 963-982.e2
- 99 Bauder M, Schmidt A, Caca K. Endoscopic full-thickness resection of duodenal lesions – a retrospective analysis of 20 FTRD cases. United Eur Gastroenterol J 2018; 6: 1015-1021
- 100 Aparicio T, Henriques J, Manfredi S. et al. Small bowel adenocarcinoma: Results from a nationwide prospective ARCAD‐NADEGE cohort study of 347 patients. Int J Cancer 2020; 147: 967-977
- 101 Yoshimizu S, Kawachi H, Yamamoto Y. et al. Clinicopathological features and risk factors for lymph node metastasis in early-stage non-ampullary duodenal adenocarcinoma. J Gastroenterol 2020; 55: 754-762
- 102 Na HK, Kim DH, Ahn JY. et al. Clinical Outcomes following Endoscopic Treatment for Sporadic Nonampullary Duodenal Adenoma. Dig Dis 2020; 38: 364-372
- 103 Klein A, Nayyar D, Bahin FF. et al. Endoscopic mucosal resection of large and giant lateral spreading lesions of the duodenum: success, adverse events, and long-term outcomes. Gastrointest Endosc 2016; 84: 688-696
- 104 Fanning SB, Bourke MJ, Williams SJ. et al. Giant laterally spreading tumors of the duodenum: endoscopic resection outcomes, limitations, and caveats. Gastrointest Endosc 2012; 75: 805-812