Gonzalez-Ortiz Dilka I, Torres-Cotto Carol, Toro Doris H, Cruz-Correa Marcia, Bigio Johanna
Department of Medicine, Gastroenterology Department. VA Caribbean Healthcare System San Juan, PR.
Bol Asoc Med P R. 2010 Oct-Dec;102(4):5-8.
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.
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.
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.
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.
十二指肠腺瘤在家族性腺瘤性息肉病患者中极为常见。在普通人群中，散发性十二指肠腺瘤并不常见。在患有十二指肠腺瘤的个体中，有人提出会同时发生结肠腺瘤，这表明存在弥漫性胃肠道黏膜增殖过程，因此建议通过结肠镜进行监测。
1997年1月至2007年7月共进行了10666例上消化道内镜检查。为每例十二指肠腺瘤患者选取4例无十二指肠腺瘤的对照。使用SPSS通过两个样本比例和卡方检验计算十二指肠息肉病与结肠腺瘤的关联。
在这10年期间，21例患者符合纳入标准。所有患者均为男性，平均年龄67岁（范围：45 - 86岁）。在病例组中，上消化道内镜检查（EGD）最常见的指征是影像学异常（47.6%）。在对照组中，EGD最常见的指征是胃肠道出血（29.8%）。大多数腺瘤位于十二指肠第二部（63%）。十二指肠腺瘤的平均大小为5mm（范围1 - 21mm）。4例（18%）腺瘤报告有高级别上皮内瘤变。散发性十二指肠腺瘤的患病率为0.2%。21例十二指肠腺瘤病例中有9例（42.8%）同时发现有结肠腺瘤。在对照组中，84例患者中有38例（45%）发现有结肠腺瘤（p = 0.21）。十二指肠息肉病与贫血、吸烟、饮酒、糖尿病病史或体重指数之间无显著统计学关联。
十二指肠息肉病的患病率较低，尽管大量息肉表现为高级别上皮内瘤变。非家族性十二指肠息肉病与结直肠腺瘤之间无统计学显著关联。我们的观察结果不支持对十二指肠息肉病患者进行早期结肠镜监测。
