Using this system, classification is determined by a fivegrade scale stage 0iv based on adenoma number. Endoscopic ultrasound in the assessment of advanced. In cases of known aetiology, gastric duodenal metaplasia gmd is a reversible lesion. Genetic studies are not performed routinely in the evaluation of sporadic polyps. Pyloric gland adenomas pgas are rare precancerous tumors typically arising from the stomach. Hps and adenoma recurrence 42 patients for whom hyperplastic polyps were the only colorectal neoplasms found on the index examination, in contrast to. Surveillance of duodenal adenomas in familial adenomatous polyposis reveals high cumulative risk of advanced disease. Duodenal polyps are a rare finding in patients presenting for gastroscopy, being found in 0. Guidelines for colonoscopy surveillance after screening. The aim of this study was to assess the natural history of untreated duodenal and ampullary adenomas in fap patients during surveillance. The aim of this study was to evaluate the risk of development of.
The most common lesions necessitating removal are duodenal adenomas which should be differentiated from other mucosal lesions such as ectopic. Pdf duodenal adenoma surveillance in patients with. Particular attention should be placed on recognizing duodenal adenomas with intestinal, gastric, and serrated phenotype, as they have an increased risk of malignant transformation if not completely excised. Incidence of sporadic and familial adenomatous polyposisrelated periampullary adenomas an understanding of the natural history of duodenal neoplasia in patients with fap is essential to the development of surveillance. Endoscopic management of nonampullary duodenal polyps. Adenomas of the major duodenal papilla, also known as ampullary. Particular attention should be placed on recognizing duodenal adenomas with. Endoscopic surveillance guidelines and recommendations for duodenal polyposis in fap and map are similar. Patients undergoing duodenal surveillance andor endoscopic therapy since 1990 were. Local endoscopic therapy options available for duodenal. Duodenal pyloric gland adenoma in a 59yearold asian male.
Selection of a treatment modality the choice of treatment modality depends on the characteristics of the adenoma, the presence of concurrent duodenal polyposis, the presence of endoscopic expertise, and the willingness of the patient to undergo longterm endoscopic surveillance following endoscopic papillectomy or surgical ampullectomy. To study the endoscopic appearance, risk factors, clinical course, and response to therapy of gastric adenomas. It is accessible by egd esophagogastroduodenoscopy and frequently biopsied. In cases of unknown aetiology, the fate of gmd remains elusive. Duodenal adenoma surveillance in patients with familial adenomatous polyposis fabio guilherme campos, marianny sulbaran, adriana vaz safatleribeiro, carlos augusto real martinez. One long term upper tract surveillance study of 114 fap patients failed to prevent.
To audit the frequency of gmd occurring in a cohort of duodenal adenomas. The impact of chromoendoscopy for surveillance of the. Adenomas are the most commonly encountered duodenal polyps, although hyperplastic polyps and other mucosal tumours such as brunners gland adenomas and hamartomas also occur. Objective current surveillance strategies for duodenal adenomatosis in familial adenomatous polyposis fap miss malignancies and underestimate cancer risk in ampullary disease. Surveillance of duodenal adenomas in familial adenomatous polyposis reveals high cumulative risk of advanced disease jeanchristophe saurin, christelle gutknecht, bertrand napoleon, annick chavaillon, rene ecochard. Although sporadic nonampullary duodenal adenoma snda is regarded as a precancerous lesion, its natural course is uncertain. Ampullary adenomas adenomas of the major duodenal papilla, also known as ampullary adenomas, can occur sporadically or in the context of genetic syndromes such as familial adenomatous. Duodenal adenomas usually are multiple, sessile, and predominantly located in the mucosal folds of the descending duodenum. Moreover, a surveillance program that was based on endoscopichistological findings and associated with early diagnosis and resection of. To determine the outcome of endoscopic management of proximal small bowel adenomas in fap pts. Risk of adenoma, advanced adenoma and crc in individuals with family history of crc 672 duodenal adenoma surveillance for familial adenomatous polyposis patients utilizing endoscopy and.
Endoscopic mucosal resection emr of a large, flat duodenal adenoma. Selection of a treatment modality the choice of treatment modality depends on the characteristics of the adenoma, the presence of concurrent duodenal polyposis, the presence of endoscopic expertise, and the willingness of the patient to undergo longterm endoscopic surveillance. Georges e alkhoury md kings county hospital center 4222005. Adenomas of the major duodenal papilla, also known as ampullary adenomas. Patients and methods a prospective, optimized, endoscopic surveillance protocol. Endoscopic management of proximal small bowel adenomas in. Recently, using magnifying endoscopy with narrow band imaging, a novel diagnostic algorithm for realtime diagnosis of nonampullary superficial duodenal epithelial tumors was developed. Gastric duodenal metaplasia in duodenal adenomas journal. It is generally accepted that surveillance for duodenal adenomas and. Assessment of duodenal adenomas and strategies for curative. Patients with large numbers of gastric and duodenal polyps and those with dysplastic polyps fgps with epithelial dysplasia and adenomas are recommended to undergo surveillance. Patients with familial adenomatous polyposis fap are known to have an increased risk for gastric adenomas.
Nonampullary duodenal adenomas are thought to progress to duodenal adenocarcinomas in a stepwise manner, with accumulation of genetic mutations, including those in apc, kras, and p53. Endoscopic management of upper gastrointestinal familial. Dna from colon cancer is shed into the fecal stream in greater quantities than dna from normal colonic mucosa. Results of ten years of followup, gastroenterology. Gastric adenomas in familial adenomatous polyposis are. Duodenal polyps and especially duodenal adenomas are.
Standard upper endoscopic surveillance is recommended based on personal history independent of apc mutation location. A read is counted each time someone views a publication summary. Duodenal adenoma surveillance in patients with familial adenomatous polyposis. In addition, another physician at the university of texas health science center at san antonio uthscsa reported another two patients with duodenal adenomas. Cryoballoon ablation for treatment of duodenal adenomas. Prevention and management of duodenal polyps in familial. The prevalence of fap associated duodenal adenomas has led to the development of spigelman classification which assigns surveillance intervals by dividing patients into four group based on size, histology and severity of dysplasia on histology7. Sporadic duodenal adenoma da 7% of duodenal polyps 6. The incidence of duodenal adenomas in map appears to be lower than in fap but the limited available data suggest a comparable increase in the relative risk and lifetime risk of duodenal cancer. Variables affecting penetrance of gastric and duodenal. The role of chromoendoscopy in the surveillance of the. Duodenal adenomas are estimated to occur in 5090% of patients with fap, with approximately 5% of duodenal polyps progressing to cancer 4, 5. Similar to that of colonic adenomas, duodenal adenomas have malignant potential and endoscopic resection er is the first line treatment. The majority of sporadic duodenal adenomas are flat or sessile and occur in the second part of the duodenum.
The role of endoscopy in ampullary and duodenal adenomas 774. Patients and methods a prospective, optimized, endoscopic surveillance protocol was applied to 58. Sporadic nonampullary duodenal adenoma in the natural. Duodenal adenomas can be found in 3070% of fap patients and the lifetime risk. Even more rarely do they arise in extragastric sites such as the duodenum and gallbladder. It is generally accepted that surveillance for duodenal adenomas and adenocarcinomas should be included in the management of patients with fap, although there are few data from clinical trials that demonstrate the effectiveness of surveillance strategies or chemoprevention for the prevention of death from duodenal. Tubular adenomas of the duodenum doctor answers on. The development of duodenal adenomas is considered a very common and important extracolonic manifestation in patients with familial adenomatous polyposis. The clinical features of gastric adenomas in fap have not been well characterized, and there is a lack of standardized approaches to the management of these lesions. Because the main objective of these surveillance programs is prevention or at least early detection of cancer, results of previous series are rather. Surveillance of duodenal adenomas in familial adenomatous. In view of this high risk of duodenal cancer in patients with advanced duodenal polyposis, upper gastrointestinal endoscopic surveillance has been.
Studies are ongoing for detection of multiarray assay for common mutations in colon cancer. Differentiating duodenal adenomas from other types of duodenal polyp, both mucosal and submucosal is crucial to allow optimum management. Duodenal adenoma surveillance in patients with familial. Surveillance and treatment of periampullary and duodenal. These adenomas can occur within and outside of genetic syndromes, and are broadly classified as nonampullary or. Surveillance of duodenal adenomas in familial adeno. I just recently had a 1cm benign tubular adenoma removed from the rectum, on. In 1989, spigelman et al developed a staging system for evaluation of the severity of duodenal adenomatosis. The duodenum is the first part of the small bowel and receives food from the stomach. Conclusions endoscopic surveillance with directed endotherapy for dls in fap is feasible and safe when diligently performed. Duodenal adenomas are the most common type of polyp arising from the duodenum. Nonampullary duodenal adenomas rarely recur after complete. However, less well appreciated by medical providers is the second leading cause of death in fap, duodenal adenocarcinoma.
The natural history of untreated duodenal and ampullary. Other gastrointestinal manifestations commonly found in fap patients are duodenal adenomas, and gastric fundic gland and adenomatous polyps. Results from recently published studies have indicated the need for lifelong surveillance. Routine surveillance and targeted endoscopic therapy have not been proven to guarantee an adenoma free or cancerfree duodenum. T1 the role of chromoendoscopy in the surveillance of the duodenum of patients with familial adenomatous polyposis. Endoscopy and eus are key for effective surveillance and. Our aim was to determine their respective frequency, risk factors, and cumulative risk. Endoscopic management of nonampullary duodenal polyps peter. None of the patients developed da during follow up. In fap patients, the efficacy of endoscopic surveillance and the optimal management of duodenal adenomas and in particular advanced adenomas have not been well established. Sporadic and familial adenomatous polyposis related adenomas show similar molecular features to colorectal adenoma, with presence of apc and kras mutations braf mutations, p53.
Duodenal adenomas with gastric phenotype are subclassified into pyloric gland adenoma and foveolar adenoma. There is a real concern regarding the duodenal bulb as some lesions can mimic duodenal adenomas in saurin jc et al. The evidence base for endoscopic resection of duodenal adenomas. Endoscopic management of duodenal adenomas in familial. The role of endoscopy in ampullary and duodenal adenomas. This study aimed to evaluate the utility of endoscopic ultrasound eus in the assessment of fap patients with duodenal. Consider pancreaticoduodenectomy for duodenal malignant villous adenomas and for villous tumors of the ampulla of vater. Georges e alkhoury md kings county hospital center. Endoscopic surveillance is recommended for patients with familial adenomatous polyposis fap because of the high prevalence of duodenal adenomas and the risk of periampullary cancer. Purpose the development of highgrade dysplasia hgd on duodenal or jejunal adenomas and of latestage stage iv duodenal polyposis are major clinical events for familial adenomatous polyposis fap patients. Surveillance of duodenal familial adenomatous polyposis. The role of endoscopy in ampullary and duodenal adenomas prepared by.
285 868 848 533 255 293 816 873 1116 107 1470 566 308 1033 3 1463 565 459 433 655 1082 661 1351 257 460 1439 751 1357 89 203 271 1304 1308 1115 1198 651 409 295 495 1445 19 1079 1241 367 717 1390