Management of Sporadic Duodenal Adenomas and the Association With Colorectal Neoplasms: A Retrospective Cohort Study

Goals: To evaluate management, outcome, and follow-up of patients with sporadic duodenal adenomas and assess the presence of colorectal neoplasms. Background: With the widespread use of esophagogastroduodenoscopy, an increasing number of sporadic duodenal adenomas are diagnosed. An optimal algorithm for management has not been fully defined. Accumulating data suggest an association with colorectal neoplasms. Study: Patients diagnosed with sporadic duodenal adenomas at our institute from 1986 until 2008 were retrospectively reviewed. Data were collected from medical records. Results: Fifty-four patients (28 men, 52%) were diagnosed with a sporadic duodenal adenoma at a median age of 59 years (range, 27 to 84 y); 33 patients (61%) underwent endoscopic or surgical intervention, 5 (9%) were only followed endoscopically, and 16 (30%) underwent no intervention or follow-up. Complete endoscopic removal was accomplished in at least 81% of cases, and no complications were reported; surgical intervention was complicated in 4 patients, with 1 resulting in death. Adenoma recurrence was 20% at a median follow-up of 18 months (range, 4 to 54 mo), but no carcinoma developed. Colorectal neoplasms were found in 16 of 29 patients (55%) who underwent colonoscopy, including 2 cancers (7%), 7 advanced adenomas (24%), and 7 nonadvanced adenomas (24%). Conclusions: Although no consistent approach to management of sporadic duodenal adenomas was followed, no duodenal carcinoma developed during the follow-up. Endoscopic intervention is preferred over surgical intervention, whenever possible. Once complete removal is ascertained, there is no strict indication for regular follow-up esophagogastroduodenoscopy, especially in elderly patients or patients with relevant comorbidity. Colonoscopic assessment is warranted in all patients diagnosed with sporadic duodenal adenomas.

[1]  A. Neugut,et al.  Sporadic Duodenal Adenoma and Association with Colorectal Neoplasia: A Case–Control Study , 2014, Digestive Diseases and Sciences.

[2]  M. Jung,et al.  Endoscopic resection of duodenal neoplasms: a single-center study , 2010, Surgical Endoscopy.

[3]  J. Rigaux,et al.  Nonampullary duodenal polyps: characteristics and endoscopic management. , 2010, Gastrointestinal Endoscopy.

[4]  D. Rockey.  Computed tomographic colonography: current perspectives and future directions. , 2009, Gastroenterology.

[5]  Apel Dariusz,et al.  Increased prevalance of colorectal adenoma in patients with sporadic duodenal adenoma , 2009, European journal of gastroenterology & hepatology.

[6]  O. Bouché,et al.  Increased risk of colonic neoplasia in patients with sporadic duodenal adenoma. , 2009, Gastroenterologie clinique et biologique.

[7]  M. Bourke,et al.  EMR of large, sessile, sporadic nonampullary duodenal adenomas: technical aspects and long-term outcome (with videos). , 2009, Gastrointestinal endoscopy.

[8]  J. Beebe-Dimmer,et al.  The epidemiology and pathogenesis of neoplasia in the small intestine. , 2009, Annals of epidemiology.

[9]  T. Ponchon,et al.  Endoscopic resection of sporadic duodenal adenomas: an efficient technique with a substantial risk of delayed bleeding. , 2008, Endoscopy.

[10]  W. Höchter,et al.  Duodenalpolypen: Häufigkeit, histologisches Substrat und Bedeutung , 1984 .

[11]  D. Heresbach,et al.  Patients with sporadic duodenal adenoma are a high‐risk group for advanced colorectal neoplasia: results of a case–control study , 2007, Alimentary pharmacology & therapeutics.

[12]  I. Blanco,et al.  [Familial adenomatous polyposis]. , 2006, Gastroenterologia y hepatologia.

[13]  A. Schneider,et al.  Frequency of colorectal polyps in patients with sporadic adenomas or adenocarcinomas of the papilla of vater--an age-matched, controlled study. , 2005, Zeitschrift fur Gastroenterologie.

[14]  D. Apel,et al.  Follow-up after endoscopic snare resection of duodenal adenomas. , 2005, Endoscopy.

[15]  D. Apel,et al.  High frequency of colorectal adenoma in patients with duodenal adenoma but without familial adenomatous polyposis. , 2004, Gastrointestinal endoscopy.

[16]  A. Ford,et al.  Sporadic duodenal adenoma and colorectal neoplasia. , 2004, Gut.

[17]  M. Catalano,et al.  Endoscopic management of adenoma of the major duodenal papilla. , 2004, Gastrointestinal endoscopy.

[18]  A. Lavergne,et al.  Sporadic duodenal adenoma is associated with colorectal neoplasia , 2004, Gut.

[19]  K. Chayama,et al.  Clinicopathologic Features and Endoscopic Resection of Early Primary Nonampullary Duodenal Carcinoma , 2003, Journal of clinical gastroenterology.

[20]  T. Ponchon,et al.  Long-term follow-up of patients with endoscopic treatment of sporadic adenomas of the papilla of vater. , 2003, Endoscopy.

[21]  E. Furth,et al.  Efficacy, safety, and clinical outcomes of endoscopic mucosal resection: a study of 101 cases. , 2002, Gastrointestinal endoscopy.

[22]  M. Stolte,et al.  Review of histological classifications of gastrointestinal epithelial neoplasia: differences in diagnosis of early carcinomas between Japanese and Western pathologists , 2001, Journal of Gastroenterology.

[23]  B. Petersen,et al.  Endoscopic surveillance and ablative therapy for periampullary adenomas , 2001, American Journal of Gastroenterology.

[24]  M F Dixon,et al.  The Vienna classification of gastrointestinal epithelial neoplasia , 2000, Gut.

[25]  P. Funch‐jensen,et al.  Prospective study of prevalence and endoscopic and histopathologic characteristics of duodenal polyps in patients submitted to upper endoscopy. , 1994, Scandinavian journal of gastroenterology.

[26]  M. Stolte,et al.  Adenoma and carcinoma of the duodenum and papilla of Vater: a clinicopathologic study. , 1992, The American journal of gastroenterology.

[27]  F. Sellner,et al.  Investigations on the significance of the adenoma‐carcinoma sequence in the small bowel , 1990, Cancer.

[28]  M. Sivak,et al.  Villous Tumors of the Duodenum , 1988, Annals of surgery.

[29]  A. I. Davidson,et al.  Operative management of tubulovillous neoplasms of the duodenum and ampulla , 1988, The British journal of surgery.

[30]  R. Ottenjann,et al.  [Duodenal polyps. Incidence, histologic substrate and significance]. , 1984, Deutsche Medizinische Wochenschrift.

[31]  K. H. Perzin,et al.  Adenomas of the small intestine: A clinicopathologic review of 51 cases and a study of their relationship to carcinoma , 1981, Cancer.

[32]  K. Lillemoe,et al.  Malignant neoplasms of the duodenum. , 1980, Surgery, gynecology & obstetrics.