-
Surgical Endoscopy Feb 2019To establish the clinical value of endoscopic papillectomy for duodenal papillary tumor based on endoscopic and clinical characteristics.
AIM
To establish the clinical value of endoscopic papillectomy for duodenal papillary tumor based on endoscopic and clinical characteristics.
PATIENTS AND METHODS
This single-center, retrospective study included 110 patients with duodenal papillary tumor who underwent endoscopic papillectomy between January 2006 and April 2017 at the gastrointestinal endoscopic center of the Chinese PLA General Hospital. Clinical data, postoperative pathology, procedure-related complications, and therapeutic outcomes were analyzed.
RESULTS
Endoscopic papillectomy was technically feasible in all patients, and was mainly performed by four experienced endoscopists. The primary success rate of endoscopic papillectomy for ampullary neoplasms was 78.2%. A total of 13 patients experienced recurrence during a mean follow-up period of 16.28 months (range 6-132 months), the predictive factors that were related to recurrence were complete resection (53.8% vs. 94.2%; P = 0.001), and final pathology findings (P = 0.001). Delayed hemorrhage, the most common procedure-related complication, occurred in 20% (22/110) of patients and was significantly related to intraoperative bleeding (P = 0.042). Pancreatitis was the second most common complication, which was closely related to intraoperative bleeding requiring intervention (P = 0.040) and larger tumor size (P = 0.044). Histology, type of resection, stent placement, sphincterotomy, and duration of procedure were not related to post-procedure hemorrhage or pancreatitis. Older age (63.7 ± 13.5 vs. 57.4 ± 12.2; P = 0.033), jaundice (47.8% vs. 13.8%; P = 0.001), endoscopic forceps biopsy diagnosis of high-grade intraepithelial neoplasia (82.6% vs. 14.9%; P = 0.001), tumor size ≥ 2 cm (60.9% vs. 34.5%; P = 0.022), and dilation of the bile duct (34.8% vs. 9.2%; P = 0.006) were clinical features for ampullary carcinoma. The rate of complete resection (52.2% vs. 92.0%; P = 0.001) and recurrence (34.8% vs. 6.8%; P = 0.001) were also related to the diagnosis of ampullary carcinoma at final pathology.
CONCLUSIONS
Endoscopic papillectomy is a feasible and reasonable option for both diagnosis and treatment of tumors of the duodenal papilla in properly selected patients.
Topics: Adult; Aged; Ampulla of Vater; Biopsy; Duodenal Neoplasms; Endoscopy, Digestive System; Feasibility Studies; Female; Humans; Male; Middle Aged; Neoplasm Staging; Retrospective Studies; Treatment Outcome
PubMed: 30421083
DOI: 10.1007/s00464-018-6577-2 -
Clinical Cancer Research : An Official... Nov 2017Duodenal polyposis and cancer are important causes of morbidity and mortality in familial adenomatous polyposis (FAP) and MUTYH-associated polyposis (MAP). This study...
Duodenal polyposis and cancer are important causes of morbidity and mortality in familial adenomatous polyposis (FAP) and MUTYH-associated polyposis (MAP). This study aimed to comprehensively characterize somatic genetic changes in FAP and MAP duodenal adenomas to better understand duodenal tumorigenesis in these disorders. Sixty-nine adenomas were biopsied during endoscopy in 16 FAP and 10 MAP patients with duodenal polyposis. Ten FAP and 10 MAP adenomas and matched blood DNA samples were exome sequenced, 42 further adenomas underwent targeted sequencing, and 47 were studied by array comparative genomic hybridization. Findings in FAP and MAP duodenal adenomas were compared with each other and to the reported mutational landscape in FAP and MAP colorectal adenomas. MAP duodenal adenomas had significantly more protein-changing somatic mutations ( = 0.018), truncating mutations ( = 0.006), and copy number variants ( = 0.005) than FAP duodenal adenomas, even though MAP patients had lower Spigelman stage duodenal polyposis. Fifteen genes were significantly recurrently mutated. Targeted sequencing of , , , and identified further mutations in each of these genes in additional duodenal adenomas. In contrast to MAP and FAP colorectal adenomas, neither exome nor targeted sequencing identified mutations ( = 0.0017). The mutational landscapes in FAP and MAP duodenal adenomas overlapped with, but had significant differences to those reported in colorectal adenomas. The significantly higher burden of somatic mutations in MAP than FAP duodenal adenomas despite lower Spigelman stage disease could increase cancer risk in the context of apparently less severe benign disease. .
Topics: Adenoma; Adenomatous Polyposis Coli; Adult; Aged; Biopsy; Carcinogenesis; DNA Glycosylases; DNA Mutational Analysis; DNA, Neoplasm; Duodenal Neoplasms; Female; Humans; Male; Middle Aged; Neoplasm Proteins; Exome Sequencing
PubMed: 28790112
DOI: 10.1158/1078-0432.CCR-17-1269 -
Journal of Clinical Gastroenterology 2017After colorectal cancer and desmoid tumors, duodenal adenocarcinoma is the next leading cause of death in familial adenomatous polyposis (FAP) patients, but it has not...
BACKGROUND
After colorectal cancer and desmoid tumors, duodenal adenocarcinoma is the next leading cause of death in familial adenomatous polyposis (FAP) patients, but it has not been thoroughly investigated.
PATIENTS AND METHODS
To investigate the clinical course of duodenal neoplasia, including adenoma and cancer, we investigated 77 Japanese FAP patients treated at the National Cancer Center Hospital, Tokyo, Japan. We evaluated the clinicopathologic features, Spigelman severity score, and management of duodenal neoplasms. Data were acquired from a prospectively enrolled database.
RESULTS
Fifty-one (66%) of the 77 FAP patients had duodenal neoplasia during this observational period, and 47 of 51 patients had extra-ampulla duodenal neoplasia; 42 (58%) had duodenal neoplasms (extra-ampulla), 4 had duodenal adenomas with high-grade dysplasia (HGD), and 1 had invasive carcinoma. Among the 45 patients (extra-ampulla) with duodenal adenoma with HGD or low-grade dysplasia, 8 (18%) patients were treated using endoscopic resection (ER). During the short observation period, ER was performed only in HGD cases. None of the patients died from duodenal neoplasia. In total, during the surveillance period, duodenal HGD was detected in 5 (63%) of 8 patients graded as Spigelman stage IV; HGD was not detected in stage 0 (n=33), I (n=0), II (n=12), or III (n=20) patients.
CONCLUSIONS
Short-interval endoscopic surveillance and appropriate ER may help prevent duodenal invasive carcinoma. In addition, there was little development of invasive carcinoma during the follow-up. The Spigelman classification is beneficial for the risk assessment of duodenal neoplasia in Japanese FAP patients.
Topics: Adenomatous Polyposis Coli; Adolescent; Adult; Biopsy; Carcinoma; Databases, Factual; Duodenal Neoplasms; Endoscopy, Digestive System; Female; Humans; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Retrospective Studies; Time Factors; Tokyo; Treatment Outcome; Tumor Burden; Young Adult
PubMed: 27306941
DOI: 10.1097/MCG.0000000000000555 -
Gastroenterology Feb 2022Gastroesophageal reflux disease (GERD) is associated with an increased risk of cancer of the upper gastrointestinal tract. This study aimed to assess whether and to what...
BACKGROUND AND AIMS
Gastroesophageal reflux disease (GERD) is associated with an increased risk of cancer of the upper gastrointestinal tract. This study aimed to assess whether and to what extent a negative upper endoscopy in patients with GERD is associated with decreased incidence and mortality in upper gastrointestinal cancer (ie, esophageal, gastric, or duodenal cancer).
METHODS
We conducted a population-based cohort study of all patients with newly diagnosed GERD between July 1, 1979 and December 31, 2018 in Denmark, Finland, Norway, and Sweden. The exposure, negative upper endoscopy, was examined as a time-varying exposure, where participants contributed unexposed person-time from GERD diagnosis until screened and exposed person-time from the negative upper endoscopy. The incidence and mortality in upper gastrointestinal cancer were assessed using parametric flexible models, providing adjusted hazard ratios (HRs) with 95% confidence intervals (CIs).
RESULTS
Among 1,062,740 patients with GERD (median age 58 years; 52% were women) followed for a mean of 7.0 person-years, 5324 (0.5%) developed upper gastrointestinal cancer and 4465 (0.4%) died from such cancer. Patients who had a negative upper endoscopy had a 55% decreased risk of upper gastrointestinal cancer compared with those who did not undergo endoscopy (HR, 0.45; 95% CI, 0.43-0.48), a decrease that was more pronounced during more recent years (HR, 0.34; 95% CI, 0.30-0.38 from 2008 onward), and was otherwise stable across sex and age groups. The corresponding reduction in upper gastrointestinal mortality among patients with upper endoscopy was 61% (adjusted HR, 0.39; 95% CI, 0.37-0.42). The risk reduction after a negative upper endoscopy in incidence and mortality lasted for 5 and at least 10 years, respectively.
CONCLUSIONS
Negative upper endoscopy is associated with strong and long-lasting decreases in incidence and mortality in upper gastrointestinal cancer in patients with GERD.
Topics: Adult; Aged; Duodenal Neoplasms; Endoscopy, Digestive System; Esophageal Neoplasms; Female; Gastroesophageal Reflux; Humans; Male; Middle Aged; Proportional Hazards Models; Risk Assessment; Stomach Neoplasms
PubMed: 34627859
DOI: 10.1053/j.gastro.2021.10.003 -
Langenbeck's Archives of Surgery Feb 2018Prophylactic colon surgery has increased life expectancy of familial adenomatous polyposis patients. Extracolonic manifestations are life limiting, above all duodenal...
INTRODUCTION
Prophylactic colon surgery has increased life expectancy of familial adenomatous polyposis patients. Extracolonic manifestations are life limiting, above all duodenal adenomas. Severe duodenal adenomatosis or cancer may necessitate pancreas-preserving total duodenectomy or partial pancreatico-duodenectomy, mostly after previous proctocolectomy and often after limited local resections of duodenal adenomas. Scarce information on long-term postoperative outcome and quality of life after surgery for duodenal adenomatosis is available. Aim of the present study was to analyze perioperative and long-term outcome after PD and PPTD for FAP-associated duodenal adenomatosis, including QoL and recurrence of adenomas in the neoduodenum after PPTD.
MATERIAL, METHODS AND PATIENTS
Thirty-eight patients, 27 after pancreas-preserving duodenectomy and 11 after partial pancreaticoduodenectomy, were included.
RESULTS
Pancreas-preserving total duodenectomy was associated with shorter operation time and less blood loss than partial pancreatico-duodenectomy. Clinically relevant pancreatic fistula occurred in 31.5%. In-hospital mortality was 5.3%. Long-term follow-up revealed recurrent pancreatitis after pancreas-preserving total duodenectomy in 22% of patients, two (7.4%) required re-operation. Recurrent adenomatosis was detected in 26% of patients. Quality of life was comparable to the German normal population after both surgical procedures. Patients with postoperative complications showed worse results than those without complications. Disease-specific 10-year survival rate with respect to duodenal adenomatosis was 100%.
CONCLUSION
Surgery for FAP-associated duodenal adenomatosis and cancer can be carried out with reasonable morbidity rates despite previous proctocolectomy. Long-term outcome, quality of life, and survival rates are favorable.
Topics: Adenomatous Polyposis Coli; Adult; Cohort Studies; Duodenal Neoplasms; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Pancreaticoduodenectomy; Postoperative Complications; Quality of Life; Survival Rate; Treatment Outcome
PubMed: 29075846
DOI: 10.1007/s00423-017-1625-2 -
Khirurgiia 2019To present the experience in diagnosis and surgical treatment of duodenal tumors.
AIM
To present the experience in diagnosis and surgical treatment of duodenal tumors.
MATERIAL AND METHODS
The study included 27 patients with different duodenal tumors: adenocarcinoma (AC, n=8), gastrointestinal stromal tumor (GIST, n=13), neuroendocrine tumor (NET, n=6). The examination included computed tomography (in 27 patients), magnetic resonance imaging (12), transcutaneous ultrasound (14), endosonography (16), esophagogastroduodenoscopy (16). All patients were operated. Conventional (18), laparoscopic (4), robot-assisted (4), endoscopic endoluminal (1) surgical interventions were performed. 17 patients were followed up from 8 months to 10 years (median 26 months).
RESULTS
According to the instrumental diagnostic methods, duodenal tumors were verified in 19 cases. Five patients with AC underwent pancreaticoduodenectomy (Whipple procedure), 2 - palliative operations (bypass gastroenteroanastomosis), 1 - explorative laparotomy. Patients with GIST underwent 3 pancreaticoduodenectomies and 10 duodenectomies: traditional (4), laparoscopic (4) and robot-assisted (2) approaches. In case of NET 3 interventions via traditional approach (pancreaticoduodenectomy, duodenal resection, tumor enucleation), 1 endoscopic endoluminal operation, 2 robot-assisted operations (duodenal resection and duodenopancreatectomy, splenectomy, distal gastrectomy) were performed. Postoperative complications occurred in 10 (37%) patients. Postoperative mortality was absent. Long-term results were analyzed in 17 patients. All patients with GIST and NET are alive without disease progression. Two AC patients are alive from those who are available.
CONCLUSION
Duodenal tumors are relatively rare. Radical surgical intervention in accordance with oncological principles is preferred for these patients. Organ-preserving procedures may be applied depending on morphological type of tumor. Examination and treatment of patients with duodenal tumors should be carried out in specialized surgical departments.
Topics: Duodenal Neoplasms; Humans; Laparoscopy; Pancreaticoduodenectomy; Treatment Outcome
PubMed: 30789602
DOI: 10.17116/hirurgia20190115 -
Gastrointestinal Endoscopy Jun 2024Endoscopic mucosal resection (EMR) with use of electrocautery (conventional EMR) has historically been used to remove large duodenal adenomas; however, use of...
BACKGROUND AND AIMS
Endoscopic mucosal resection (EMR) with use of electrocautery (conventional EMR) has historically been used to remove large duodenal adenomas; however, use of electrocautery can predispose to adverse events including delayed bleeding and perforation. Cold snare EMR (cs-EMR) has been shown to be safe and effective for removal of colon polyps, but data regarding its use in the duodenum are limited. The aim of this study was to evaluate the efficacy and safety of cs-EMR for nonampullary duodenal adenomas ≥1 cm.
METHODS
This was a multicenter retrospective study of patients with nonampullary duodenal adenomas ≥1 cm who underwent cs-EMR from October 2014 to May 2023. Patients who received any form of thermal therapy were excluded. Primary outcomes were technical success and rate of recurrent adenoma. Secondary outcomes were adverse events and predictors of recurrence.
RESULTS
A total of 125 patients underwent resection of 127 nonampullary duodenal adenomas with cs-EMR. Follow-up data were available in 89 cases (70.1%). The recurrent adenoma rate was 31.5% (n = 28). Adverse events occurred in 3.9% (n = 5), with 4 cases of immediate bleeding (3.1%) and 1 case of delayed bleeding (.8%). There were no cases of perforation. The presence of high-grade dysplasia was found to be an independent predictor of recurrence (odds ratio, 10.9 [95% confidence interval, 1.1-102.1]; P = .036).
CONCLUSIONS
This retrospective multicenter study demonstrates that cs-EMR for nonampullary duodenal adenomas is safe and technically feasible with an acceptable recurrence rate. Future prospective studies are needed to directly compare outcomes of cs-EMR with conventional and underwater EMR.
Topics: Humans; Duodenal Neoplasms; Male; Endoscopic Mucosal Resection; Female; Middle Aged; Retrospective Studies; Aged; Adenoma; Treatment Outcome; Neoplasm Recurrence, Local; Tumor Burden; Aged, 80 and over; Adult; Postoperative Hemorrhage
PubMed: 38092125
DOI: 10.1016/j.gie.2023.12.007 -
Histopathology Aug 2017Extra-ampullary duodenal adenoma (EADA) is a rare condition with poorly described clinicopathological details. In this study, we aimed to characterize EADA...
AIMS
Extra-ampullary duodenal adenoma (EADA) is a rare condition with poorly described clinicopathological details. In this study, we aimed to characterize EADA clinicopathologically.
METHODS AND RESULTS
We performed a retrospective review of 44 serial cases of EADA. Each EADA was categorized as either gastric-type (n = 5) or intestinal-type (n = 39). All gastric-type adenomas were located in the first portion of the duodenum and exhibited a pedunculated shape. Gastric-type adenomas were classified into two subtypes: pyloric gland and foveolar. The former consisted of mucin 6 (MUC6)-positive glands covered with MUC5AC-positive cells, whereas nearly all the latter consisted of MUC5AC-positive cells. When EADAs were categorized into high and low grades, approximately 40% (16 of 44) were high-grade. The high-grade adenomas were significantly larger than the low-grade adenomas (19.4 ± 8.6 mm versus 11.8 ± 5.1 mm, P = 0.021), and all adenomas greater than 20 mm in largest diameter were categorized as high-grade adenomas. Among 16 individuals who underwent total colonoscopy before or after duodenal mucosal resection, nine had a colorectal neoplasm, and all nine duodenal lesions were of the intestinal phenotype.
CONCLUSIONS
We clarified the clinicopathological characteristics of gastric- and intestinal-type EADAs. EADAs greater than 20 mm at the largest diameter were consistently high-grade, and are thought to have the potential to progress to adenocarcinoma. These findings should be helpful for the clinical management of EADA.
Topics: Adenoma; Adult; Aged; Duodenal Neoplasms; Female; Humans; Male; Middle Aged; Precancerous Conditions; Retrospective Studies
PubMed: 28211946
DOI: 10.1111/his.13192 -
Clinical Journal of Gastroenterology Oct 2015Carcinosarcoma is a biphasic malignant tumor consisting of both carcinomatous and sarcomatous components, and its occurrence in the duodenum is very rare. In the present... (Review)
Review
Carcinosarcoma is a biphasic malignant tumor consisting of both carcinomatous and sarcomatous components, and its occurrence in the duodenum is very rare. In the present report, we describe a case of so-called carcinosarcoma of the duodenum with a chondrosarcomatous component. A 79-year-old man was referred to our hospital because of anorexia, weight loss, and jaundice. A preoperative imaging examination showed a hypovascular mass located in the pancreatic head. Histological examination of specimens obtained through a forceps biopsy revealed anaplastic carcinoma (spindle cell type), and a pancreatoduodenectomy was performed. Histologically, the tumor showed an elevated lesion with a wide base in proximity to duodenal mucosal carcinoma. The tumor was found to be predominantly composed of sarcoma with carcinomatous and chondrosarcomatous components. There was a transitional zone between the carcinomatous and sarcomatous components, and a portion of the sarcomatous component was positive for cytokeratin, and negative for vimentin. As mentioned above, we diagnosed the lesion as so-called carcinosarcoma with a chondrosarcomatous component.
Topics: Aged; Carcinosarcoma; Duodenal Neoplasms; Humans; Immunohistochemistry; Keratins; Male; Pancreaticoduodenectomy; Vimentin
PubMed: 26249526
DOI: 10.1007/s12328-015-0595-6 -
Human Pathology Jul 2017We compared the incidence, esophagogastroduodenoscopy (EGD) findings, and histopathologic characteristics of gastric and duodenal follicular lymphomas (FL). Of 626 FL... (Comparative Study)
Comparative Study
We compared the incidence, esophagogastroduodenoscopy (EGD) findings, and histopathologic characteristics of gastric and duodenal follicular lymphomas (FL). Of 626 FL cases, primary gastric FL and secondary gastric involvement of FL were observed in 1% and 5% of the cases, respectively, which were lower incidences than duodenal FL (10% and 9%, respectively). Gastric FL usually appeared as submucosal tumors (primary, 71%; secondary, 79%), whereas duodenal FL, as granular lesions (primary, 92%: secondary, 87%). In the granular duodenal lesions, the neoplastic follicles were located sparsely on the muscularis mucosa and could be found between villi, whereas in the stomach, similar lesions were hidden within the lamina propria, and only larger lesions such as submucosal tumors could be detected on the mucosal surface. The differences in the incidences and EGD findings were considered to be associated with structural differences of the lamina propria. Typical FL features: grades 1-2 histology, follicularity, and CD10 and/or BCL6 and BCL2 were usually observed in all primary and secondary gastric and duodenal FL. Gastroduodenal and bone marrow involvement were found in 12% and 33% of the cases, respectively, and there was no significant correlation between them (P=.095). Twenty-nine cases (5%) were up-staged by gastroduodenal-positive results. In conclusion, the histopathology of gastric FL was similar to that of duodenal and nodal FL; the differences in the incidence and EGD findings between gastric and duodenal FL were considered to be associated with structural difference of the lamina propria, and EGD was useful as a staging procedure.
Topics: Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; Disease-Free Survival; Duodenal Neoplasms; Endoscopy, Digestive System; Female; Gastric Mucosa; Humans; Immunohistochemistry; In Situ Hybridization, Fluorescence; Incidence; Intestinal Mucosa; Kaplan-Meier Estimate; Lymphoma, Follicular; Male; Middle Aged; Neoplasm Staging; Stomach Neoplasms; Time Factors; Tokyo
PubMed: 28504205
DOI: 10.1016/j.humpath.2017.04.025