De Novo Development of Hamartomatous Duodenal Polyps in a Patient With Short Bowel Syndrome During Teduglutide Therapy: A Case Report

Abstract

Teduglutide (TG) is approved for the treatment of parenteral nutrition (PN)-dependent adult patients with short bowel syndrome (SBS). Its well-known adverse effect is expedited growth of colon polyps and potential formation of new polyps. Apart from animal studies, de novo development of duodenal polyps in a patient during TG therapy has not been reported in the literature. We report a case of a 71-year-old man with SBS on TG who developed multiple new duodenal polyps that were found incidentally during a diagnostic endoscopy. Furthermore, an accelerated growth of duodenal polyps was noted while on TG therapy, suggesting a potential trophic effect of TG on these polyps. There are no current recommendations for the surveillance of intestinal polyps in patients on TG therapy, but we recommend exercising caution and possible need for surveillance based on this case report.

De Novo Development of Distal Jejunal and Duodenal Adenomas After 41 Months of Teduglutide Treatment in a Patient With Short‐Bowel Syndrome: A Case Report

“…6,8 The occurrence of small-intestinal neoplasms has not been reported so far, but recently, a case about de novo development of duodenal polyps has been published. 9 In this report, hamartomatous but not adenomatous histomorphology was observed and, thus, is not yet suggestive for induction of neoplastic epithelial proliferation. We report a case of de novo development of small-intestinal premalignant adenomatous polyps in both bulbar duodenum and distal jejunum in a patient who has been receiving teduglutide treatment for 41 months.…”

“…Additionally, a further low‐grade tubular adenoma was observed in the duodenum after 41 months of treatment, which developed to detectability after the last endoscopy performed 17 months after treatment. In our center, upper endoscopies are also carried out annually in patients receiving teduglutide therapy as a precautionary measure, but the presented case and also the hamartomatous duodenal polyp reported by Ukleja et al may argue for expanding surveillance by this additional procedure 9 . Medical treatment of rheumatoid arthritis with methotrexate and rituximab up to now has not been associated with increased risk for gastrointestinal cancers in long‐term surveillance studies 11,12 .…”

“…In our center, upper endoscopies are also carried out annually in patients receiving teduglutide therapy as a precautionary measure, but the presented case and also the hamartomatous duodenal polyp reported by Ukleja et al may argue for expanding surveillance by this additional procedure. 9 Medical treatment of rheumatoid arthritis with methotrexate and rituximab up to now has not been associated with increased risk for gastrointestinal cancers in long-term surveillance studies. 11,12 However, the influence of immunosuppressive agents in combination with a protrophic therapy is yet unknown and needs further observation.…”

“…At present, endoscopic surveillance is limited to (1) careful screening for colonic neoplasia before teduglutide treatment initiation and (2) follow‐up colonoscopies during treatment. Upper endoscopic surveillance is not recommended for patients receiving teduglutide yet 8,9 . In a recent case report, potential formation of small‐bowel hamartomatous polyps during teduglutide therapy, which do not represent epithelial neoplasia as suspected as GLP‐2‐analogue effect, was reported 9 .…”

“…However, these surveillance endoscopies are limited to colonoscopies, which are recommended prior to treatment, yearly during the first 2 years, and, if without significant results, subsequently at a 5‐year interval during therapy 6,8 . The occurrence of small‐intestinal neoplasms has not been reported so far, but recently, a case about de novo development of duodenal polyps has been published 9 . In this report, hamartomatous but not adenomatous histomorphology was observed and, thus, is not yet suggestive for induction of neoplastic epithelial proliferation.…”