Background and Aims: Endoscopic treatment for duodenal neoplasms is associated with a high risk of perforation. This study aimed to determine the feasibility of endoscopic treatment for sporadic nonampullary duodenal adenoma (SNDA). Methods: Consecutive patients undergoing endoscopic treatment for SNDA between January 2005 and December 2015 were included in the study. Clinical characteristics and endoscopic outcomes were analyzed using medical records. Long-term outcome was assessed in patients whose follow-up period was >12 months >1 year. Results: A total of 95 lesions (92 patients) were treated with argon plasma coagulation (APC) ablation (n = 25), endoscopic mucosal resection (EMR, n = 59), or endoscopic submucosal dissection (ESD, n= 11). The median age was 54.9 years, and 63% were male. In patients who underwent EMR and ESD, the en bloc resection rate was 83.1 and 90.0% (p > 0.99); and the complete resection rate was 81.4 and 80% (p > 0.99), respectively. Perforation occurred in 8 patients (8.7%), 4 of whom required surgery. The ESD group showed a significantly higher perforation rate than APC or EMR group (45.5 vs. 0 and 5.1%; p < 0.001). During the median follow-up period of 19 months (range 12–137 months), one patient in the APC ablation group experienced recurrence; no recurrences were seen among EMR and ESD groups. Conclusions: Favorable long-term outcomes indicate that endoscopic treatment is an effective approach for the treatment of SNDA. Considering the high risk of perforation associated with ESD, APC, or EMR may be an acceptable alternative.

Keywords:
Duodenum, Adenoma, Endoscopic mucosal resection, Argon plasma coagulation
1.
Jung SH, Chung WC, Kim EJ, Kim SH, Paik CN, Lee BI, et al. Evaluation of non-ampullary duodenal polyps: comparison of non-neoplastic and neoplastic lesions.
World J Gastroenterol
. 2010 Nov;16(43):5474–80.
2.
Lim CH, Cho YS. Nonampullary duodenal adenoma: current understanding of its diagnosis, pathogenesis, and clinical management.
World J Gastroenterol
. 2016 Jan;22(2):853–61.
3.
Sellner F. Investigations on the significance of the adenoma-carcinoma sequence in the small bowel.
Cancer
. 1990 Aug;66(4):702–15.
4.
Seifert E, Schulte F, Stolte M. Adenoma and carcinoma of the duodenum and papilla of Vater: a clinicopathologic study.
Am J Gastroenterol
. 1992 Jan;87(1):37–42.
5.
Galandiuk S, Hermann RE, Jagelman DG, Fazio VW, Sivak MV. Villous tumors of the duodenum.
Ann Surg
. 1988 Mar;207(3):234–9.
6.
Miller JH, Gisvold JJ, Weiland LH, McIlrath DC. Upper gastrointestinal tract: villous tumors.
AJR Am J Roentgenol
. 1980 May;134(5):933–6.
7.
Yamamoto H, Miura Y. Duodenal ESD: conquering difficulties.
Gastrointest Endosc Clin N Am
. 2014 Apr;24(2):235–44.
8.
Endo M, Abiko Y, Oana S, Kudara N, Chiba T, Suzuki K, et al. Usefulness of endoscopic treatment for duodenal adenoma.
Dig Endosc
. 2010 Oct;22(4):360–5.
9.
Nonaka S, Oda I, Tada K, Mori G, Sato Y, Abe S, et al. Clinical outcome of endoscopic resection for nonampullary duodenal tumors.
Endoscopy
. 2015 Feb;47(2):129–35.
10.
Yamasaki Y, Uedo N, Takeuchi Y, Ishihara R, Okada H, Iishi H. Current status of endoscopic resection for superficial nonampullary duodenal epithelial tumors.
Digestion
. 2018;97(1):45–51.
11.
Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4).
Gastric Cancer
. 2017 Jan;20(1):1–19.
12.
Kim SG, Park CM, Lee NR, Kim J, Lyu DH, Park SH, et al. Long-term clinical outcomes of endoscopic submucosal dissection in patients with early gastric cancer: A prospective multicenter cohort study.
Gut Liver
. 2018 Jul;12(4):402–10.
13.
Yamamoto Y, Yoshizawa N, Tomida H, Fujisaki J, Igarashi M. Therapeutic outcomes of endoscopic resection for superficial non-ampullary duodenal tumor.
Dig Endosc
. 2014 Apr;26 Suppl 2:50–6.
14.
Honda T, Yamamoto H, Osawa H, Yoshizawa M, Nakano H, Sunada K, et al. Endoscopic submucosal dissection for superficial duodenal neoplasms.
Dig Endosc
. 2009 Oct;21(4):270–4.
15.
Jung JH, Choi KD, Ahn JY, Lee JH, Jung HY, Choi KS, et al. Endoscopic submucosal dissection for sessile, nonampullary duodenal adenomas.
Endoscopy
. 2013;45(2):133–5.
16.
Matsumoto S, Miyatani H, Yoshida Y. Endoscopic submucosal dissection for duodenal tumors: a single-center experience.
Endoscopy
. 2013;45(2):136–7.
17.
Seo JY, Hong SJ, Han JP, Jang HY, Myung YS, Kim C, et al. Usefulness and safety of endoscopic treatment for nonampullary duodenal adenoma and adenocarcinoma.
J Gastroenterol Hepatol
. 2014 Sep;29(9):1692–8.
18.
Marques J, Baldaque-Silva F, Pereira P, Arnelo U, Yahagi N, Macedo G. Endoscopic mucosal resection and endoscopic submucosal dissection in the treatment of sporadic nonampullary duodenal adenomatous polyps.
World J Gastrointest Endosc
. 2015 Jun;7(7):720–7.
19.
Navaneethan U, Lourdusamy D, Mehta D, Lourdusamy V, Venkatesh PG, Sanaka MR. Endoscopic resection of large sporadic non-ampullary duodenal polyps: efficacy and long-term recurrence.
Surg Endosc
. 2014 Sep;28(9):2616–22.
20.
Kakushima N, Ono H, Takao T, Kanemoto H, Sasaki K. Method and timing of resection of superficial non-ampullary duodenal epithelial tumors.
Dig Endosc
. 2014 Apr;26 suppl 2:35–40.
21.
Hara Y, Goda K, Dobashi A, Ohya TR, Kato M, Sumiyama K, et al. Short- and long-term outcomes of endoscopically treated superficial non-ampullary duodenal epithelial tumors.
World J Gastroenterol
. 2019 Feb;25(6):707–18.
22.
Bourke MJ. Endoscopic resection in the duodenum: current limitations and future directions.
Endoscopy
. 2013;45(2):127–32.
23.
Kakushima N, Kanemoto H, Tanaka M, Takizawa K, Ono H. Treatment for superficial non-ampullary duodenal epithelial tumors.
World J Gastroenterol
. 2014 Sep;20(35):12501–8.
24.
Inoue T, Uedo N, Yamashina T, Yamamoto S, Hanaoka N, Takeuchi Y, et al. Delayed perforation: a hazardous complication of endoscopic resection for non-ampullary duodenal neoplasm.
Dig Endosc
. 2014 Mar;26(2):220–7.
25.
Mori H, Shintaro F, Kobara H, Nishiyama N, Rafiq K, Kobayashi M, et al. Successful closing of duodenal ulcer after endoscopic submucosal dissection with over-the-scope clip to prevent delayed perforation.
Dig Endosc
. 2013 Jul;25(4):459–61.
26.
Takimoto K, Imai Y, Matsuyama K. Endoscopic tissue shielding method with polyglycolic acid sheets and fibrin glue to prevent delayed perforation after duodenal endoscopic submucosal dissection.
Dig Endosc
. 2014 Apr;26 suppl 2:46–9.
27.
Valerii G, Tringali A, Landi R, Boškoski I, Familiari P, Bizzotto A, et al. Endoscopic mucosal resection of non-ampullary sporadic duodenal adenomas: a retrospective analysis with long-term follow-up.
Scand J Gastroenterol
. 2018 Apr;53(4):490–4.
28.
Alexander S, Bourke MJ, Williams SJ, Bailey A, Co J. EMR of large, sessile, sporadic nonampullary duodenal adenomas: technical aspects and long-term outcome (with videos).
Gastrointest Endosc
. 2009 Jan;69(1):66–73.
29.
Lépilliez V, Chemaly M, Ponchon T, Napoleon B, Saurin JC. Endoscopic resection of sporadic duodenal adenomas: an efficient technique with a substantial risk of delayed bleeding.
Endoscopy
. 2008 Oct;40(10):806–10.
30.
Okada K, Fujisaki J, Kasuga A, Omae M, Kubota M, Hirasawa T, et al. Sporadic nonampullary duodenal adenoma in the natural history of duodenal cancer: a study of follow-up surveillance.
Am J Gastroenterol
. 2011 Feb;106(2):357–64.
© 2020 S. Karger AG, Basel
2020
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.