Abstract
Background
Endoscopic resection is an alternative to surgery for removal of large duodenal polyps. There are limited data on the safety, efficacy, and long-term recurrence data after endoscopic resection of sporadic, non-ampullary, and large duodenal polyps.
Objective
Our aim was to evaluate the safety and short-term outcomes of the endoscopic removal of the large sporadic duodenal polyps and to determine long-term risk of recurrence and factors predicting recurrence on follow-up.
Methods
Patients with large (>10 mm) sporadic non-ampullary duodenal polyps underwent endoscopic resection from 2001 to 2012 at the Cleveland Clinic. Patients underwent endoscopic polypectomy and argon plasma coagulation. The main outcome measurements were complete polypectomy, complications, short- and long-term recurrence.
Results
A total of 54 patients were included. The mean patient age was 66.4 years. The mean polyp size was 15.1 ± 5.4 mm. Most polyps (N = 48, 88.9 %) were sessile polyps. The median follow-up time was 10.8 (range 0.5–120) months. Most lesions were located in the second part of the duodenum (N = 41, 75.9 %). Adenomas were found in 46 (85.2 %) of lesions overall. Tubular adenoma was the most common histology type found in 33 cases (71.7 %). Tubulovillous and villous were found in 12 (26.1 %) and 1 (2.2 %) cases, respectively. On follow-up, 50 (92.6 %) achieved complete resection with tumor free margins post resection. The 30-day risk of major complications was 5.6 % (N = 3), 1 with perforation and 2 with delayed bleeding. Recurrence was documented in 29 % (N = 16) of patients. All recurrences were managed endoscopically except for one patient who required surgery. The recurrence rate was higher for patients who had villous component in their adenomas compared to those with tubular alone (p = 0.03).
Conclusions
Endoscopic resection is effective for treating large duodenal adenomas. Adenomas with villous features are more likely to recur. Almost all recurrences can be managed endoscopically.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Abbreviations
- APC:
-
Argon plasma coagulation
- EMR:
-
Endoscopic mucosal resection
- FAP:
-
Familial adenomatous polyposis
References
Murray MA, Zimmerman MJ, Ee HC (2004) Sporadic duodenal adenoma is associated with colorectal neoplasia. Gut 53:261–265
Apel D, Jakobs R, Spiethoff A et al (2005) Follow-up after endoscopic snare resection of duodenal adenomas. Endoscopy 37:444–448
Waye JD, Barkun A, Goh KL et al (2002) Approach to benign duodenal polyps. Gastrointest Endosc 55:962–966
Spigelman AD, Talbot IC, Penna C, Nugent KP, Phillips RK, Costello C, DeCosse JJ (1994) Evidence for adenoma-carcinoma sequence in the duodenum of patients with familial adenomatous polyposis. The Leeds Castle Polyposis Group (Upper Gastrointestinal Committee). J Clin Pathol 47(8):709–710
Adler DG, Qureshi W, Davila R et al (2006) The role of endoscopy in ampullary and duodenal adenomas. Gastrointest Endosc 64:849–854
Sohn JW, Jeon SW, Cho CM et al (2010) Endoscopic resection of duodenal neoplasms: a single-center study. Surg Endosc 24:3195–3200
Lépilliez V, Chemaly M, Ponchon T et al (2008) Endoscopic resection of sporadic duodenal adenomas: an efficient technique with a substantial risk of delayed bleeding. Endoscopy 40:806–810
Alexander S, Bourke MJ, Williams SJ et al (2009) EMR of large, sessile, sporadic nonampullary duodenal adenomas: technical aspects and long-term outcome (with videos). Gastrointest Endosc 69:66–73
Fanning SB, Bourke MJ, Williams SJ, Chung A, Kariyawasam VC (2012) Giant laterally spreading tumors of the duodenum: endoscopic resection outcomes, limitations, and caveats. Gastrointest Endosc 75(4):805–812
Gonzalez-Ortiz DI, Torres-Cotto C, Toro DH, Cruz-Correa M, Bigio J (2010) Duodenal adenomas in nonpolyposis syndrome patients are not associated to colorectal neoplasia. Bol Asoc Med P R 102(4):5–8
van Heumen BW, Mul K, Nagtegaal ID, van Kouwen MC, Nagengast FM (2012) Management of sporadic duodenal adenomas and the association with colorectal neoplasms: a retrospective cohort study. J Clin Gastroenterol 46(5):390–396
Bourke MJ (2013) Endoscopic resection in the duodenum: current limitations and future directions. Endoscopy 45:127–132
Kim HK, Chung WC, Lee BI, Cho YS (2010) Efficacy and long-term outcome of endoscopic treatment of sporadic nonampullary duodenal adenoma. Gut Liver 4(3):373–377
Lienert A, Bagshaw PF (2007) Treatment of duodenal adenomas with endoscopic argon plasma coagulation. ANZ J Surg 77(5):371–373
Galandiuk S, Hermann RE, Jagelman DG, Fazio VW, Sivak MV (1988) Villous tumours of the duodenum. Ann Surg 207(3):234–239
Farnell MB, Sakorafas GH, Sarr MG, Rowland CM, Tsiotos GG, Farley DR, Nagorney DM (2000) Villous tumors of the duodenum: reappraisal of local vs. extended resection. J Gastrointest Surg 4(1):13–21
Sakorafas GH, Friess H, Dervenis CG (2000) Villous tumors of the duodenum: biologic characters and clinical implications. Scand J Gastroenterol 35(4):337–344
Disclosures
Udayakumar Navaneethan, Dennisdhilak Lourdusamy, Dhruv Mehta, Vennisvasanth Lourdusamy, Preethi GK Venkatesh, Madhusudhan R Sanaka have no financial ties to disclosures.
Conflict of interest
The authors declared no financial conflict of interest
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Navaneethan, U., Lourdusamy, D., Mehta, D. et al. Endoscopic resection of large sporadic non-ampullary duodenal polyps: efficacy and long-term recurrence. Surg Endosc 28, 2616–2622 (2014). https://doi.org/10.1007/s00464-014-3512-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-014-3512-z