Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Apr 16, 2017; 9(4): 196-203
Published online Apr 16, 2017. doi: 10.4253/wjge.v9.i4.196
Endoscopic assessment and management of sporadic duodenal adenomas: The results of single centre multidisciplinary management
Kheman Rajkomar, Michelle Kweon, Imran Khan, Paul Frankish, Michael Rodgers, Jonathan B Koea
Kheman Rajkomar, Michelle Kweon, Michael Rodgers, Jonathan B Koea, the Department of Surgery, North Shore Hospital, Private Bag 93503, Takapuna, Auckland, New Zealand
Imran Khan, Paul Frankish, the Department of Gastroenterology, North Shore Hospital, Private Bag 93503, Takapuna, Auckland, New Zealand
Author contributions: All authors were involved in the design, analysis and interpretation of the study results as well as manuscript preparation and review; Rajkomar K and Khan I were also involved in data acquistion.
Institutional review board statement: This investigation was reviewed and approved by the Awhina Health and Knowledge Centre, North Shore Hospital, Auckland, New Zealand.
Informed consent statement: All study participants provided written informed consent prior to study enrolment.
Conflict-of-interest statement: None to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Jonathan B Koea, Chief of Upper gastrointestinal Unit, the Department of Surgery, North Shore Hospital, Private Bag 93503, Takapuna, Auckland, New Zealand. jonathan.koea@waitematadhb.govt.nz
Telephone: +64-9-4868900 Fax: +64-9-4884621
Received: July 23, 2016
Peer-review started: July 26, 2016
First decision: September 29, 2016
Revised: January 22, 2017
Accepted: February 28, 2017
Article in press: March 1, 2017
Published online: April 16, 2017
Processing time: 265 Days and 8.6 Hours
Abstract
AIM

To review the role of multidisciplinary management in treating sporadic duodenal adenomas (SDA).

METHODS

SDA managed at North Shore Hospital between 2009-2014 were entered into a prospective database. Pathology, endoscopic and surgical management as well as follow up were reviewed.

RESULTS

Twenty-eight patients (14 male: Median age 68 years) presented with SDA [18 were classified as non ampullary location (NA), 10 as ampullary location (A)]. All SDA were diagnosed on upper gastrointestinal endoscopy and were imaged with a contrast enhanced CT scan of the chest, abdomen and pelvis. Of the NA adenomas 14 were located in the second part, 2 in the first part and 2 in the third part of the duodenum. Two patients declined treatment, 3 patients underwent surgical resection (2 transduodenal resections and 1 pancreaticoduodenectomy), and 23 patients were treated with endoscopic mucosal resection (EMR). The only complication with endoscopic resection was mild pancreatitis post procedure. Patients were followed with gastroduodenoscopy for a median of 22 mo (range: 2-69 mo). There were 8 recurrences treated with EMR with one patient proceeding to pancreaticodeuodenectomy because of high grade dysplasia in the resected specimen and 2 NA recurrences were managed with surgical resection (distal gastrectomy for a lesion in the first part of the duodenum and a transduodenal resection of a lesion in the third part of the duodenum).

CONCLUSION

SDA can be treated endoscopically with minimal morbidity and piecemeal resection results in eradication in nearly three quarters of patients. Recurrent SDA can be treated with endoscopic reresection with surgical resection indicated when the lesions are large (> 4 cm in diameter) or demonstrate severe dysplasia or invasive cancer.

Keywords: Duodenal adenoma; Endoscopic resection; Surgical resection; Pancreaticoduodenectomy; Endoscopic surveillance; Dysplasia

Core tip: Sporadic duodenal adenomas can be treated endoscopically with minimal morbidity and even piecemeal resection results in eradication in nearly three quarters of patients. Optimal surveillance strategies include re-endoscopy 6 mo after the initial resection is a satisfactory starting point. Recurrent sporadic adenomas can be treated with endoscopic re-resection with surgical resection indicated when the lesions are large (> 3 cm in diameter) or demonstrate severe dysplasia or invasive cancer.