Introduction We reviewed the management of Duodenal adenomas at James Paget University Hospital, Great Yarmouth between 2001 and 2013.
Methods 20 patients were included in this study. A standardised proforma was completed for each case and the information was then collated.
Results A CT scan was performed in 13/20 patients. 3/20 had CT and Endoscopic Ultrasound. 4/20 had no imaging. 14/20 patients had Endoscopic Mucosal Resection (EMR). 5/20 had surgery. 1/20 case was monitored with annual surveillance OGDs. 11/14 patients had EMR within 6 months of diagnosis. Complete resection was achieved in 11/14. Argon Plasma Coagulation (APC) was used in 3/14.
The American Society of Gastroenterology guidelines1 recommend routine insertion of prophylactic pancreatic stents for patients undergoing EMR of Ampullary adenomas. 6 of our patients had EMR for Ampullary adenoma and only 1 had a Pancreatic stent inserted. However none of these procedures were complicated by Pancreatitis. 4/14 patients had serious complications following EMR. 3 of these had bleeding from the EMR site while one had a large mucosal defect needing Endoclip application. The 30 day mortality was 0. The frequency of long term follow up was in compliance with the Spigelman scoring system.5 4/14 patients had recurrent Duodenal adenomas after EMR.
Various studies have previously demonstrated a high incidence of co-existing Colorectal neoplasms in patients with sporadic Duodenal adenomas.2–4 The same was observed in our patients. Of the 17/20 patients who had Duodenal adenomas and intact colons, 11 had a colonoscopy. 3 were found to have Colon cancer, 4 had Colonic adenomas and 1 had hyperplastic polyps.
Conclusion We recommend imaging for all polyps >1 cm. All patients should have EMR within 6 months of diagnosis. Only 1/6 patients who had EMR of ampullary lesions had a Pancreatic stent inserted. None developed Pancreatitis. 4/14 had serious complications following EMR. Long term follow up was in compliance with Spigelman scoring system. 4/14 had recurrent Duodenal adenomas after EMR. 3 patients were found to have Colon cancer. So it is essential that all patients with Duodenal adenomas have a colonoscopy.
The role of endoscopy in ampullary and duodenal adenomas. Gastrointestinal Endoscopy 2006; 64(6)
Murray et al., Sporadic duodenal adenoma is associated with colorectal neoplasia. Gut 2004
Ramsoekh et al., Sporadic duodenal adenoma and the association with colorectal neoplasia: a case-control study. The American Journal of Gastroenterology 2008
van Heumen et al., Management of sporadic duodenal adenomas and the association with colorectal neoplasms: a retrospective cohort study.J Clin Gastroenterol 2012 May
Spigelman et al., Upper gastrointestinal cancer in patients with familial adenomatous polyposis. Lancet 1989
Disclosure of Interest None Declared.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.