Pavlovic-Markovic Aleksandra, Dragasevic Sanja, Krstic Miodrag, Stojkovic Lalosevic Milica, Milosavljevic Tomica
Clinic for Gastroenterology and Hepatology, Clinical Center Serbia, Belgrade, Serbia,
School of Medicine, University of Belgrade, Belgrade, Serbia,
Dig Dis. 2019;37(5):374-380. doi: 10.1159/000496697. Epub 2019 Mar 28.
The increasing incidence of duodenal neoplasm has underlined different methods of resection depending on the clinical presentation, endoscopic features and histopathology. In this comprehensive review, we systematically describe the current knowledge concerning the diagnosis and management of duodenal adenomas (DAs) and discuss data considering all possible therapeutic approaches.
Among a variety of duodenal lesions, including neuroendocrine tumors and gastrointestinal stromal tumors, DAs present precancerous lesions of the duodenal papilla or non-ampullary region necessitating removal. DAs can occur sporadically (SDA) as rare lesions or relatively common in polyposis syndromes. The endoscopic resections of DA are associated with an increased degree of complexity due to distinctive anatomical properties of the duodenal wall, luminal diameter and the presence of ampulla with pancreatic and biliary drainage. The endoscopic techniques including cold snare polypectomy (CSP), endoscopic mucosal resection (EMR), and argon plasma coagulation ablation are suggested to be less invasive than surgical treatment, associated with shorter hospital stay and lower cost. According to the current clinical practice, surgery has been accepted as standard therapeutic approach in familial adenomatous polyposis patients with severe polyposis or DA not amenable to endoscopic resection. Key Messages: The strategy for endoscopic resection of DAs depends on the lesion size, morphology, location, and histopathology findings. Small adenomas are most frequently diagnosed and removed by standard CSP techniques, while large laterally spreading lesions and ampullary adenoma are referred for EMR or endoscopic papillectomy respectively. Screening colonoscopy is indicated in patients with SDA. Additional studies for new endoscopic strategies and techniques for curative therapy of DAs are needed to refine future management decisions. Complete resection of DA is considered curative, but nevertheless, long-term endoscopic follow-up is still required to detect and treat any recurrent arising lesions.
十二指肠肿瘤发病率的上升凸显了根据临床表现、内镜特征和组织病理学采用不同的切除方法。在本综述中，我们系统地描述了有关十二指肠腺瘤（DA）诊断和管理的当前知识，并讨论了考虑所有可能治疗方法的数据。
在包括神经内分泌肿瘤和胃肠道间质瘤在内的多种十二指肠病变中，DA是十二指肠乳头或非壶腹区域的癌前病变，需要切除。DA可散发性发生（SDA），为罕见病变，或在息肉病综合征中相对常见。由于十二指肠壁独特的解剖特性、管腔直径以及存在带有胰胆管引流的壶腹，DA的内镜切除具有更高的复杂性。包括冷圈套息肉切除术（CSP）、内镜黏膜切除术（EMR）和氩等离子体凝固消融在内的内镜技术被认为比手术治疗侵入性小，住院时间短且成本低。根据当前临床实践，手术已被接受为患有严重息肉病或无法进行内镜切除的DA的家族性腺瘤性息肉病患者的标准治疗方法。关键信息：DA的内镜切除策略取决于病变大小、形态、位置和组织病理学结果。小腺瘤最常通过标准CSP技术诊断和切除，而大的侧向扩散性病变和壶腹腺瘤分别采用EMR或内镜乳头切除术。SDA患者应进行结肠镜筛查。需要进一步研究新的内镜策略和技术用于DA的根治性治疗，以完善未来的管理决策。DA的完整切除被认为是治愈性的，但尽管如此，仍需要长期内镜随访以检测和治疗任何复发的病变。
