Table 4

 Endoscopic treatment for duodenal neoplastic lesions

AuthorTreatmentFollow upPatientsOutcomePostoperative
NS, not stated; PDT, photodynamic therapy; ALA, 5-aminolaevulinic acid; HpD, haematoporphyrin derivate or Photofrin; FAP, familial adenomatous polyposis.
Soravia52Endoscopic resection nos4–34 months
>(mean 18)
6 FAPRecurrence of duodenal adenomas in all 5 surviving patients1 patient died of acute pancreatitis after endoscopic ampullectomy
Bertoni53Snare papillectomy18 months2 FAPRecurrence in 1 patient, successfully retreated1 oozing-type haemorrhage and 1 mild pancreatitis, controlled by conservative measures
Morpurgo44Snare polypectomy (3) argon plasma therapy (2)6–24 months
>(mean 19)
5 FAPRecurrence in 3 patientsNo postoperative complications
Alarcon46Snare polypectomy and thermal contact ablation14–83 months
>(mean 43.5)
3 FAPRecurrence in 3 patientsNS
Heiskanen5Snare excision (5), YAG laser coagulation (1)0.4–15.1 years
>(median 6.8)
6 FAPNo significant difference in Spigelman stage preoperative and at latest endoscopyPatient treated with YAG laser developed mild pancreatitis
Norton54Ampullary ablative therapy1–134 months
>(median 24)
59 FAP, 32 sporadicReturn to normal histology in 44% of sporadic and 34% of FAP lesions12 patients had mild complications, 3 severe complications: 1 duodenal stenosis, 1 postcoagulation syndrome, 1 necrotising pancreatitis
Norton55Snare excision of papilla2–32 months
>(median 9)
15 FAP, 11 sporadicRecurrence rate of adenomatous tissue of 10%2 minor bleedings, 4 mild pancreatitis, 1 duodenal perforation
Mlkvy49PDT with ALA or Photofrin4 FAP patients with duodenal polypsSuperficial necrosis and no polyp reduction after PTD with ALA. Deep necrosis and moderate polyp reduction after PDT using Photofrin.Mild skin photosensitivity using Photofrin
Regula48PDT with ALA2 duodenal adenomas, 3 ampullary carcinomasSuperficial necrosis of adenomas and in 2 adenocarcinomas. 1 adenocarcinoma unaffected.Side effects included mild skin photosensitivity, nausea/vomiting, and transient increases in ASAT
Loh50PDT with HpD or Photofrin3–50 months
>(median 5.5)
8 patients with 9 colorectal adenomas7 adenomas successfully eradicatedNo local complications
Abulafi51PDT with HpD10 patients with ampullary carcinoma unsuitable for surgeryRemission for 8–12 months in 3 patients with small tumours. In 4 patients with small tumours bulk was reduced. No improvement in patients with extensive disease3 patients with moderate skin sensitisation