Primary adenocarcinoma of the duodenum is rare. An extensive experience with fiberoptic esophagogastro‐duodenoscopy in our institution has indicated that duodenal neoplasms may be more frequent than suspected and are readily diagnosed by this modality. With this in mind, clinical, pathological, diagnostic and therapeutic aspects of the 71 patients with primary carcinoma of the duodenum reported in the literature in the last 10‐year period, 1965–1974, were reviewed. It would appear that fiberoptic endoscopy of the upper gastrointestinal tract should become the major diagnostic tool for this disease. It enables biopsies, brushings and washings to be taken. A preoperative histological diagnosis ensures that both patient and surgeon can be prepared for major abdominal surgery. It is imperative that during the endoscopic examination, the entire duodenum be examined. Pancreatico‐duodenectomy appears to offer the best chance of long term survival in patients whose lesion is resectable. The role and value of adjuvant chemo‐ and radiotherapy is still to be determined.
During a 6-year period from 1976 to 1982, 7346 gastrointestinal endoscopy procedures were performed in the Surgical Endoscopy Unit of Beth Israel Medical Center. This report summarizes our experience with 443 gastroduodenal polyps excised in 257 patients. Of these, 123 were male and 134 female, ranging in age from 19 to 92. The vast majority were between the ages of 60 and 80. With one exception, polyps varied from 0.3 cm to 6 cm in diameter (one patient had a 12-cm hyperplastic polyp). There were 399 gastric polyps in 238 patients and 44 duodenal polyps in 19 patients. Of the polyps excised, 282 (63.1%) were sessile and 161 (36.9%) were pedunculated. The majority of the patients (185) had a single polyp and 72 patients had two or more polyps. Seven patients with multiple polyps had Peutz-Jeghers Syndrome and two patients had Gardner's Syndrome. Hyperplastic polyps constituted the majority (62%) of the polyps. These polyps have minimal, if any, tendency to degenerate into carcinoma. In contrast, adenomatous gastroduodenal polyps (21%) have a definite propensity to degenerate into carcinoma. This occurred in 9.6% of the patients in this series. There were no deaths and only two complications (bleeding) in this series.
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