Follow-Up after Endoscopic Snare Resection of Duodenal Adenomas

 

 Buy Article Permissions and Reprints

Background and Study Aims: Premalignant duodenal polyps are considered to be rare. Recurrence after local excision is reported to be frequent, so many authors propose radical surgical treatment of these tumors. The aim of this study was to determine the long-term outcome after endoscopic resection of duodenal adenomas.
Patients and Methods: Between January 1990 and April 2003 we retrospectively evaluated a group of patients who presented with nonampullary duodenal villous tumors but who did not have a polyposis syndrome.
Results: Duodenal polyps were diagnosed in 21 patients during routine endoscopy during the study period. Of these, 18 patients (6 men, 12 women; median age 67, range 50 - 81), with a total of 20 duodenal adenomas, were enrolled into the study. The median size ± SD of the tumors was 27.5 ± 12 mm (range 8 - 50 mm). Of these 20 tumors, 18 adenomas were tubulovillous, one was tubulous and one was villous. Nineteen polyps were treated by snare excision and one adenoma was treated with argon plasma coagulation alone. Argon plasma coagulation was applied to polyps in six patients after snare excision during this initial treatment phase. The success rate for endoscopic adenoma removal after a 3-month interval was 55 %. After a median follow-up period of 71 months (range 22 - 151 months), 12 patients remained in remission. Local recurrences of the lesion occured in five patients (25 %) and these were re-treated. None of the patients developed carcinoma during the follow-up period.
Conclusions: Endoscopic snare excision of duodenal adenomas is an effective mode of treatment but an endoscopic surveillance program is mandatory in order to detect and treat recurrence.

References

• 1 Ryan D P, Schapiro R H, Warshaw A L. Villous tumors of the duodenum.  Ann Surg. 1986;  203 301-306
  CrossrefPubMedGoogle Scholar
• 2 Galandiuk S, Hermann R E, Jagelman D G. et al . Villous tumors of the duodenum.  Ann Surg. 1988;  207 234-239
  CrossrefPubMedGoogle Scholar
• 3 Haglund U, Fork F T, Genell S, Rehnberg O. Villous adenomas in the duodenum.  Br J Surg. 1985;  72 26-27
  PubMedGoogle Scholar
• 4 Bugra D, Alper A, Goksen Y, Emre A. Villous tumors of the duodenum.  Hepatogastroenterology. 1991;  38 84-85
  PubMedGoogle Scholar
• 5 Bjork K J, Davis C J, Nagorney D M, Mucha P . Duodenal villous tumors.  Arch Surg. 1990;  125 961-965
  PubMedGoogle Scholar
• 6 Blackman E, Nash S V. Diagnosis of duodenal and ampullary epithelial neoplasms by endoscopic biopsy: a clinicopathologic and immunohistochemical study.  Hum Pathol. 1985;  16 901-910
  CrossrefPubMedGoogle Scholar
• 7 Chappuis C W, Divincenti F C, Cohn I . Villous tumors of the duodenum.  Ann Surg. 1989;  209 593-599
  PubMedGoogle Scholar
• 8 Motton G, Veraldi G F, Fracastoro G. et al . Vater’s papilla and periampullary area villous adenoma: personal experience about nine cases and review of the literature.  Hepatogastroenterology. 1996;  43 448-455
  PubMedGoogle Scholar
• 9 Cooperman M, Clausen K P, Hecht C. et al . Villous adenomas of the duodenum.  Gastroenterology.. 1978;  74 1295-1297
  PubMedGoogle Scholar
• 10 Leborgne J, Armstrong O, Le N eel . et al . Villous tumors of the duodenum: apropos of 7 tumors, including 3 degenerated forms.  Ann Chir. 1984;  38 37-43
  PubMedGoogle Scholar
• 11 Miller J H, Gisvold J J, Weiland L H, McIlrath D C. Upper gastrointestinal tract: villous tumors.  AJR Am J Roentgenol. 1980;  134 933-936
  PubMedGoogle Scholar
• 12 Perzin K H, Bridge M F. Adenomas of the small intestine: a clinicopathologic review of 51 cases and a study of their relationship to carcinoma.  Cancer. 1981;  48 799-819
  CrossrefPubMedGoogle Scholar
• 13 Schulten M F, Oyasu R, Beal J M. Villous adenoma of the duodenum: a case report and review of the literature.  Am J Surg. 1976;  132 90-96
  CrossrefPubMedGoogle Scholar
• 14 Krukowski Z H, Ewen S W, Davidson A I, Matheson N A. Operative management of tubulovillous neoplasms of the duodenum and ampulla.  Br J Surg. 1988;  75 150-153
  PubMedGoogle Scholar
• 15 Dupont-Lampert V, Landmann J. Tubulo-villous adenoma of the duodenum: case report and review of the literature.  Schweiz Med Wochenschr. 1989;  119 1057-1059
  PubMedGoogle Scholar
• 16 Inderbitzi R, Caduff B, Bannwart F, Schwarz H. A villous adenoma of the duodenum.  Dtsche Med Wochenschr. 1992;  117 296-300
  PubMedGoogle Scholar
• 17 Will U, Bosseckert H, Schroder H. et al . Problems in diagnosis and therapy of juxtapapillary, tubulovillous adenoma.  Z Gastroenterol. 1999;  37 1013-1017
  PubMedGoogle Scholar
• 18 Scott-Coombes D M, Williamson R C. Surgical treatment of primary duodenal carcinoma: a personal series.  Br J Surg. 1994;  81 1472-1474
  PubMedGoogle Scholar
• 19 Batra S K, Schuman B M, Reddy R R. The endoscopic variety of duodenal villous adenoma: an experience with ten cases.  Endoscopy. 1983;  15 89-92
  PubMedGoogle Scholar
• 20 Vara-Thorbeck C, Salvi-Martinez M. Villous adenoma of the duodenum: case report.  Acta Chir Scand. 1989;  155 71-73
  PubMedGoogle Scholar
• 21 Pezet D, Rotman N, Slim K. et al . Villous tumors of the duodenum: a retrospective study of 47 cases by the French Associations for Surgical Research.  J Am Coll Surg. 1995;  180 541-544
  PubMedGoogle Scholar
• 22 Catania G, Cardi F, Migliore M, Romeo G. Villous adenocarcinoma of the duodenum invading the ampulla of Vater: case report and review of literature.  HPB Surg. 1996;  10 105-109
  PubMedGoogle Scholar
• 23 Farnell M B, Sakorafas G H, Sarr M G. et al . Villous tumors of the duodenum: reappraisal of local vs. extended resection.  J Gastrointest Surg. 2000;  4 13-23
  CrossrefPubMedGoogle Scholar
• 24 Treitschke F, Beger H G. Local resection of benign periampullary tumors.  Ann Oncol. 1999;  10 (Suppl 4) 212-214
  CrossrefPubMedGoogle Scholar
• 25 Sakorafas G H, Friess H, Dervenis C G. Villous tumors of the duodenum: biologic characters and clinical implications.  Scand J Gastroenterol. 2000;  35 337-344
  CrossrefPubMedGoogle Scholar
• 26 Ikeda K, Miyauchi K, Fujimoto A. et al . A case of pedunculated tubulovillous adenoma of the duodenum.  Am J Gastroenterol. 1998;  93 1159-1162
  CrossrefPubMedGoogle Scholar
• 27 Ghilain J M, Dive C. Endoscopic laser therapy for small villous adenomas of the duodenum.  Endoscopy. 1994;  26 308-310
  PubMedGoogle Scholar
• 28 Paraf F, Naveau S, Zourabichvili O. et al . Endoscopic laser therapy for duodenal villous adenoma.  Dig Dis Sci. 1989;  34 1466-1467
  CrossrefPubMedGoogle Scholar
• 29 Haubrich W S. Late recurrence of a duodenal villous adenoma.  Gastrointest Endosc. 1986;  32 372-373
  PubMedGoogle Scholar

D. Apel, M. D.

Medizinische Klinik I · Theresienkrankenhaus Mannheim

Bassermannstrasse 1 · 68165 Mannheim · Germany

Fax: +49-621-4244512

Email: darekapel@yahoo.de