Treatment of Duodenal Adenomas With Endoscopic Argon Plasma Coagulation

Lienert, Andrew; Bagshaw, Philip

doi:10.1111/j.1445-2197.2007.04063.x

Cited by 22 publications

(13 citation statements)

References 13 publications

(35 reference statements)

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“…Lienert et al[46] assessed 16 cases of NA treated with APC ± polypectomy where 3 of the 4 recurrences were successfully treated with ablative therapy. Apel et al[10] had assessed 18 cases of non-ampullary adenoma, with a median size of 27.5 mm, treated with a combination of serial sessions of polypectomy and APC (33 sessions) carried out over 3 wk to achieve a 55% success rate although 6 cases could not be eradicated despite multimodal endoscopic therapy.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic assessment and management of sporadic duodenal adenomas: The results of single centre multidisciplinary management

Rajkomar

Kweon

Khan

et al. 2017

WJGE

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AIMTo review the role of multidisciplinary management in treating sporadic duodenal adenomas (SDA).METHODSSDA managed at North Shore Hospital between 2009-2014 were entered into a prospective database. Pathology, endoscopic and surgical management as well as follow up were reviewed.RESULTSTwenty-eight patients (14 male: Median age 68 years) presented with SDA [18 were classified as non ampullary location (NA), 10 as ampullary location (A)]. All SDA were diagnosed on upper gastrointestinal endoscopy and were imaged with a contrast enhanced CT scan of the chest, abdomen and pelvis. Of the NA adenomas 14 were located in the second part, 2 in the first part and 2 in the third part of the duodenum. Two patients declined treatment, 3 patients underwent surgical resection (2 transduodenal resections and 1 pancreaticoduodenectomy), and 23 patients were treated with endoscopic mucosal resection (EMR). The only complication with endoscopic resection was mild pancreatitis post procedure. Patients were followed with gastroduodenoscopy for a median of 22 mo (range: 2-69 mo). There were 8 recurrences treated with EMR with one patient proceeding to pancreaticodeuodenectomy because of high grade dysplasia in the resected specimen and 2 NA recurrences were managed with surgical resection (distal gastrectomy for a lesion in the first part of the duodenum and a transduodenal resection of a lesion in the third part of the duodenum).CONCLUSIONSDA can be treated endoscopically with minimal morbidity and piecemeal resection results in eradication in nearly three quarters of patients. Recurrent SDA can be treated with endoscopic reresection with surgical resection indicated when the lesions are large (> 4 cm in diameter) or demonstrate severe dysplasia or invasive cancer.

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Section: Discussionmentioning

confidence: 99%

Endoscopic assessment and management of sporadic duodenal adenomas: The results of single centre multidisciplinary management

Rajkomar

Kweon

Khan

et al. 2017

WJGE

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“…In addition to standard surgical resection, the literature describes other options of endoscopic therapy—polypectomy or mucosectomy, as well as argon plasma coagulation—that show good results and few complications. Due to a relatively frequent recurrence of adenomas, patients require long-term observation [8, 14]. In our patient, it was possible to remove the large adenomas using a polypectomy snare and the small ones using argon plasma coagulation.…”

Section: Discussionmentioning

confidence: 99%

Multiple Adenomatous Duodenal Polyposis

Zádorová

Hajer

Mandys

2013

Case Reports in Gastrointestinal Medicine

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Multiple duodenal polyps are a relatively rare finding, usually co-occurrent with familial adenomatous polyposis (FAP).We report a patient with multiple duodenal adenomas and a negative examination for FAP: multiple flat polyps were detected endoscopically in a 37-year-old male patient, extending from the apex of the bulb to the end of the descending part of the duodenum. In terms of histology, they were tubular adenomas with moderate dysplasia. Colonoscopy and enteroclysis were normal. Both push and capsule enteroscopy only showed multiple polyps in the area of the descending duodenum. DNA analysis of the APC gene was as follows: DGGE, exon 1–15, deletion at codons 1309 and 1061 by means of PCR for attenuated APC were negative. Afterwards we screened the patient for germline MYH mutations using the denaturing high-performance liquid chromatography (DHPLC) in combination with sequencing. No novel pathogenic mutation has been identified. Large polyps were removed by means of endoscopic polypectomy and mucosectomy, while small polyps were removed by means of argon plasma coagulation.We conduct yearly checkups, removing only sporadic polyps. The rare finding of duodenal polyposis not co-occurrent with FAP proves that multiple adenomas in the digestive tube need not necessarily co-occur with FAP.

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“…Because of the considerable morbidity and mortality, there has been increased interest in less extensive operations for the management of benign disease. Alternate strategies include endoscopic resection, piecemeal [2], snaring [2, 4], or fulguration, argon plasma coagulation [3], trans-duodenal resection [5], and pancreas-preserving duodenectomy [6]. These procedures limit the complications of surgery or post-operative morbidity, whilst attempting to maintain adequate disease control.…”

Section: Discussionmentioning

confidence: 99%

“…A proportion of these have high-grade dysplasia and need some form of intervention to prevent the progression to carcinoma. There are a range of options to manage the adenomas, from less invasive endoscopic resections [2, 3, 4] to surgical resection [5] and pancreaticoduodenectomy [6, 7]. This paper describes the management and outcome of two patients who presented with high-grade villous adenomas of the ampulla.…”

Section: Introductionmentioning

confidence: 99%

Management of Duodenal Adenomas Involving the Ampulla of Vater – A Warning against Limited Resection

Rossaak

Bagshaw²,

Connor³

2008

Case Rep Gastroenterol

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Duodenal adenomas are uncommon, however, when present a proportion have dysplasia associated with the adenoma and therefore require treatment. The options range from less invasive endoscopic treatments to a pancreaticoduodenectomy. This case report describes two patients with adenomas involving the ampulla of Vater. One patient had familial adenomatous polyposis, the other was a renal transplant patient with a large adenoma. Both patients’ adenomas contained high-grade dysplasia. Both patients underwent a pancreaticoduodenectomy. Histology of both specimens demonstrated that the adenoma had migrated up the bile duct for at least 7 mm, and the pancreatic duct for 8 mm in one patient. Limited resection of ampullary adenomas may leave residual adenomatous tissue in the bile duct with the risk of recurrent adenomatous disease and malignant transformation.

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Treatment of Duodenal Adenomas With Endoscopic Argon Plasma Coagulation

Abstract: Argon plasma coagulation may be safe and effective for the treatment of duodenal adenomas, but further research is required. Progression of adenomas is slow and perhaps no treatment is required.

Cited by 22 publications

References 13 publications

Endoscopic assessment and management of sporadic duodenal adenomas: The results of single centre multidisciplinary management

Endoscopic assessment and management of sporadic duodenal adenomas: The results of single centre multidisciplinary management

Multiple Adenomatous Duodenal Polyposis

Management of Duodenal Adenomas Involving the Ampulla of Vater – A Warning against Limited Resection

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