Flat duodenal adenoma
Thursday 09 April 2009, Branislav Kunčak, M. D.
Adenoma of the descending part of the duodenum with nonpolypoid morphology
(depressed lesion 5 mm in a diameter- type IIc lesion according to Paris classification).
Finding in a patient without FAP.
- occur in the context of genetic syndromes such as FAP or Peutz-Jeghers syndrome
- common in patients with FAP
- occur sporadically
- sporadic duodenal adenomas are uncommon
- ampullary adenomas- adenomas of the major duodenal papilla
- nonampullary adenomas- adenomas of the duodenum that do not involve the major duodenal papilla
- have malignant potential
- other types of duodenal polyps:
- inflammatory polyps
- Brunner´s gland hyperplasia
- duodenal gastric metaplasia
- neuroendocrine tumors
- multiple, small, sessile polyps in the duodenal bulb are often benign
- substantial number of polyps in the descending duodenum are adenomas
Nonampullary sporadic duodenal adenomas
- rule out FAP, Peutz-Jeghers syndrome
- side-viewing endoscope or EUS if it is unclear wheather polyp involve the ampulla
- EUS (if endoscopic finding is suspicious for malignancy, biopsy showed high-grade dysplasia or if polyp is larger than 2 cm)
- ablative therapy (APC, laser) for small lesions as an alternative to polypectomy or EMR
- surgical resection (lesion suspicious for malignancy, larger lesions or lesions with greater than 1/3 circumferential involvement of the lumen should be considered for surgical resection)
- postprocedure surveillance
- individuals with sporadic duodenal adenomas appear to be at a significantly higher risk of colorectal neoplasia, and therefore should undergo screening colonoscopy
»Jepsen JM et al. Prospective Study of Prevalence and Endoscopic and Histopathologic Characteristics of Duodenal Polyps in Patients Submitted to Upper Endoscopy. Scand J Gastroenterol. 1994 Jun; 29(6):483-7.
»Ramsoekh D et al. Sporadic Duodenal Adenoma and the Association With Colorectal Neoplasia: A Case-Control Study. Am J Gastroenterol. 2008 Jun;103(6):1505-9.
»Lepilliez V. et al. Endoscopic resection of sporadic duodenal adenomas: an efficient technique with a substantial risk of delayed bleeding. Endoscopy. 2008 Oct;40(10):806-10. Epub 2008 Sep 30