Udd Marianne, Lindström Outi, Tenca Andrea, Rainio Mia, Kylänpää Leena
Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Gastroenterology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Scand J Gastroenterol. 2023 Feb;58(2):208-215. doi: 10.1080/00365521.2022.2114810. Epub 2022 Sep 5.
Although sporadic non-ampullary duodenal adenomas (SNADA) are rare, with the risk of progression to cancer, they deserve therapy. Endoscopic therapy of SNADA is effective, but with the increased risk of complications, endotherapy should be performed in high-volume units. The results of endotherapy of SNADA in our unit are presented.
A total of 97 patients with SNADA had endoscopic resection in 2005-2021 and control endoscopies between 3 and 24 months. Snare polypectomy, endoscopic mucosal resection (EMR), endoscopic band ligation (EBL) and endoloop were used (en bloc 37% and piecemeal 63%). In cases of residual/recurrent adenomas, endotherapy was repeated.
The median size of the adenoma was 12 (5-60) mm and most polyps were sessile (25%) or flat (65%). Primary endotherapy eradicated adenomas in 57 (59%) cases. Residual and recurrence rates were 24% ( = 23) and 17% ( = 16) with successful endotherapy in 16 (70%) and 13 (81%) patients. Endotherapy was successful in 86 (89%) patients after a median (range) follow-up of 23 (1-166) months. Four out of 11 patients with failed endotherapy had surgery; seven patients were not fit for surgery. There were no disease-specific deaths or carcinoma. Eleven patients (11%) suffered from complications: perforation requiring surgery ( = 1), sepsis ( = 1), postprocedure bleeding ( = 7), cardiac arrest ( = 1) and coronary infarct ( = 1). The thirty-day mortality was zero. Colonoscopy was performed on 67 (69%) patients with neoplastic lesions in 33% patients during follow-up.
Endotherapy of SNADA is effective and safe. Repeat endotherapy in residual and recurrent adenomas is successful. Careful patient selection is mandatory. ASA: American Society of Anesthesiologist classification; BMI: body mass index; CT: computed tomography; EBL: endoscopic band ligation; EMR: endoscopic mucosal resection; ESD: endoscopic submucosal dissection; ET: endotherapy; FAP: familial adenomatous polyposis; F: female; LST: laterally spreading tumours; M: male; SD: standard deviation; SNADA: sporadic nonampullary duodenal adenoma.
尽管散发性非壶腹十二指肠腺瘤（SNADA）较为罕见，但存在进展为癌症的风险，因此值得治疗。SNADA的内镜治疗是有效的，但随着并发症风险的增加，内镜治疗应在高容量单位进行。本文介绍了我们单位SNADA内镜治疗的结果。
2005年至2021年期间，共有97例SNADA患者接受了内镜切除，并在3至24个月内进行了内镜复查。使用圈套息肉切除术、内镜黏膜切除术（EMR）、内镜套扎术（EBL）和内镜圈套器（整块切除率为37%，分片切除率为63%）。对于残留/复发性腺瘤病例，重复进行内镜治疗。
腺瘤的中位大小为12（5 - 60）mm，大多数息肉为无蒂（25%）或扁平状（65%）。初次内镜治疗在57例（59%）患者中根除了腺瘤。残留率和复发率分别为24%（n = 23）和17%（n = 16），16例（70%）和13例（81%）成功接受内镜治疗的患者出现残留和复发。在中位（范围）随访23（1 - 166）个月后，86例（89%）患者的内镜治疗成功。11例内镜治疗失败的患者中有4例接受了手术；7例患者不适合手术。没有疾病特异性死亡或癌变病例。11例患者（11%）出现并发症：需要手术的穿孔（n = 1）、败血症（n = 1）、术后出血（n = 7）、心脏骤停（n = 1）和冠状动脉梗死（n = 1）。30天死亡率为零。67例（69%）患者在随访期间进行了结肠镜检查，其中33%的患者有肿瘤性病变。
SNADA的内镜治疗有效且安全。对残留和复发性腺瘤进行重复内镜治疗是成功的。必须仔细选择患者。ASA：美国麻醉医师协会分级；BMI：体重指数；CT：计算机断层扫描；EBL：内镜套扎术；EMR：内镜黏膜切除术；ESD：内镜黏膜下剥离术；ET：内镜治疗；FAP：家族性腺瘤性息肉病；F：女性；LST：侧向扩散肿瘤；M：男性；SD：标准差；SNADA：散发性非壶腹十二指肠腺瘤
