Updates in endoscopic management of ampullary and duodenal adenomas

Abstract

Purpose of review Adenomas are the most common benign lesions of the gastrointestinal tract. The current review aims to summarize recent literature regarding risk factors, natural history, diagnostic and staging technique, and management strategies for ampullary and nonampullary duodenal adenomas. Recent findings Recent studies identified several possible risks factors for duodenal adenomas (e.g., cholecystectomy, proton pump inhibitor use), although these associations require corroboration. Chromoendoscopy and endocystoscopy may offer accuracy comparable to biopsies in expert hands. Recent publications underscore the reduction in morbidity with endoscopic resection for lesions without signs of malignancy with submucosal invasion. Submucosal injection did not improve safety of endoscopic ampullectomy. Summary Surveillance may be a reasonable strategy for sub-centimeter ampullary adenomas occurring in familial adenomatous polyposis, as they carry a relatively low risk of malignancy. Endoscopic resection is the preferred strategy over surgery in patients without lesions suggestive of invasive malignancy. For nonampullary duodenal adenomas, several endoscopic resection techniques are available, each with their unique advantages and trade-offs. In patients who are not operative candidates but have intraductal extension, endoscopic ablation is an emerging option.

Risk Factors, Prognostic Factors, and Nomograms for Distant Metastasis in Patients with Diagnosed Duodenal cancer: A Population- Based Study

“…However, current adjuvant chemotherapy continues to play a crucial role in prolonging patients' lives, and some clinical trials are still ongoing [31][32][33] . Surgery remains the primary choice for the treatment of early stage duodenal cancer, and it still plays a role in the management of patients with advanced-stage duodenal cancer [34][35] . Remarkably, our ndings demonstrated that the lack of surgical intervention and chemotherapy exerted a substantial detrimental effect on overall survival (OS), consistent with the aforementioned outcomes.…”