Endoscopic assessment and management of sporadic duodenal adenomas: The results of single centre multidisciplinary management

• 作者: Imran Khan Jonathan B Koea Kheman Rajkomar Michael Rodgers Michelle Kweon Paul Frankish
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: 十二指肠的腺瘤 内视镜的切除术 外科的切除术 PANCREATICODUODENECTOMY 内视镜的监视 发育异常
• 年，卷（期）: 2017,（4）
• 页码范围: 196-203
• 页数: 8页
• 分类号: R735.31

摘要

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.