Clinical characteristics and course of sporadic non-ampullary duodenal adenomas: A multicenter retrospective study

Hiromitsu Kanzaki, Kazuhiro Matsueda, Masahiro Nakagawa, Tomoki Inaba, Masahiro Takatani, Ryuta Takenaka, Masao Yoshioka, Atsushi Imagawa, Masafumi Inoue, Seiyuu Suzuki, Jun Tomoda, Masaya Iwamuro, Seiji Kawano, Yoshiro Kawahara, Takehiro Tanaka, Hiroyuki Okada

Research output: Contribution to journalArticlepeer-review

Abstract

ABSTRACT: Sporadic non-ampullary duodenal adenoma (SNADA) is a rare disease, and therefore, its clinical characteristics have not been comprehensively investigated. Furthermore, owing to the high complication rates and severity of endoscopic resection, treatment strategies vary among facilities. In the present study, we aimed to clarify the clinical characteristics and course of SNADA.We extracted clinical and histological records of SNADA cases diagnosed in 11 hospitals between September 1999 and August 2014. The patients were divided into "no-resection" and "resection" groups based on the initial treatment approach. We investigated the long-term outcome of the "no-resection" group and treatment results of the "resection" group, with particular interest in endoscopic resection.Overall, 299 patients were diagnosed with SNADA. The median age at diagnosis was 67 years (range, 31-88 years), with approximately twice as many men as women. The median tumor size was 8.0 mm (2-60 mm). In total, 161 patients were initially selected for no-resection and 138 underwent resection. Age >70 years and the presence of either severe illness or poor performance status were significantly related to opting for no-resection. In the no-resection group, 101 patients underwent endoscopic follow-up for at least 1 year. During the observational period (2.5 ± 2.2 years), 27 lesions (27%) disappeared following cold forceps biopsy, and 13 lesions (14%) presented lateral growth. Four lesions (4%) changed to mucosal carcinoma, 3 were treated endoscopically, and 1 was surgically resected. Nineteen patients died; however, no one died of duodenal carcinoma. In the endoscopic resection group, en bloc resection was achieved in 78% of patients. However, the complication rate for perforation was 7%, and endoscopic submucosal dissection was associated with a 36% perforation rate.With the low incidence of cancer development and no disease specific death, the strategy of initially not performing resection could be considered especially for the older adults, poor-prognosis patients, or small lesions.

Original languageEnglish
Pages (from-to)e27382
JournalMedicine
Volume100
Issue number39
DOIs
Publication statusPublished - Oct 1 2021

ASJC Scopus subject areas

  • Medicine(all)

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