Duodenal adenomas in nonpolyposis syndrome patients are not associated to colorectal neoplasia.

BACKGROUND

Duodenal adenomas are extremely common in patients with familial adenomatous polyposis. In the general population, sporadic duodenal adenomas are an uncommon finding. Among individuals with duodenal adenomas, the development of concurrent colonic adenomas has been proposed, suggesting a diffuse gastrointestinal mucosa proliferative process and thus surveillance with colonoscopy.

METHODS

A total of 10,666 upper endoscopies were performed from January 1997 to July 2007. Four controls without duodenal adenomas were selected for each case. Association of duodenal polyposis with colonic adenomas was calculated using two sample proportions and chi square using SPSS.

RESULTS

In the 10-year period, 21 patients met inclusion criteria. All the patients were male with a mean age of 67 years (range: 45-86 years). Among cases, the most common indication for upper gastrointestinal endoscopy (EGD) was an abnormal imaging (47.6%). For controls, the most common indication for EGD was gastrointestinal bleeding (29.8%). Most adenomas were located in the second portion of the duodenum (63%). Mean size for duodenal adenomas was 5mm (range 1-21mm). High grade dysplasia was reported in 4 (18%) adenomas. The prevalence of sporadic duodenal adenomas was 0.2%. Nine of 21(42.8%) duodenal adenoma cases were found with concurrent colonic adenomas. In the control group, 38 of 84 (45%) patients were found with colon adenomas (p = 0.21). There was no significant statistical association between duodenal polyposis and anemia, smoking, alcohol, medical history of diabetes mellitus or BMI.

CONCLUSION

Prevalence of duodenal polyposis was low, although a high number of polyps exhibited high grade dysplasia. There was no statistically significant association between nonfamilial duodenal polyposis and colorectal adenomas. Our observations do not support early colonoscopy surveillance for patients with duodenal polyposis.