Endoscopic therapy of sporadic non-ampullary duodenal adenomas, single centre retrospective analysis

Figures & data

Flowchart 1. Enrolled and excluded patients with duodenal polyps.

Table 1. Patient demographics, comorbidities and indication of diagnostic gastroscopy in 97 patients with sporadic non-ampullary duodenal adenomas.

	n = 97	%
Age; mean; median (range)	66.6; 68 (22–89)	–
BMI kg/m^2; mean; median (range)	27.9; 27.6 (20–41.7)	–
Sex male/female	49/48	51/49
ASA 1–2	37	38
ASA 3–4	60	62
Comorbidities
Cardiovascular	61	63
Diabetes	22	23
Pulmonary	14	14
Other	43	44
Oral anticoagulant	19	20
Symptom
Anaemia	26	27
GI-bleeding	5	5
Dyspepsia	33	34
Abdominal pain	17	18
Incidental finding	29	30
Colonoscopy performed	67	69
Adenoma in colonoscopy	20	–
Carcinoma in colonoscopy	3	–
No colonoscopies	30	31

ASA: American Society of Anaesthesiologists classification; BMI: body mass index

Figure 1. The final treatment success of endoscopic therapy of sporadic non-ampullary duodenal adenomas in different adenoma locations, oral and distal from ampulla of Vateri.

Table 2. Polyp morphology: size, Paris classification, laterally spreading tumour (LST) classification in total and in final endotherapy success and failure.

SNADA morphologic factors		Total n = 97	Success n = 86	Failure n = 11	p
Polyp size	< 10 mm	7 (7)	7 (8)	0	<0.001
	10–19 mm	49 (51)	46 (53)	3 (27)
	20–29 mm	24 (25)	23 (27)	1 (9)
	≥30 mm	17 (13)	10 (12)	7 (64)
Ip (pedunculated)		2 (2)	2 (2)	0	0.5
Isp (subpedunculated)		8 (8)	7 (8)	1 (9)
*Is (sessile)		24 (25)	21 (24)	3 (27)
0–IIa (flat elevation of mucosa)		53 (55)	49 (57)	4 (36)
0–IIa/c (flat elevation and central depression)		7 (7)	5 (6)	2 (18)
0–IIb (flat mucosal change)		3 (3)	2 (2)	1 (9)
*LST-Granular		58 (73)	53 (76)	5 (50)	0.08
*LST-Nongranular		22 (27)	17 (24)	5 (50)

LST: laterally spreading tumour; *flat lesion ≥ 10 mm.

Table 3. Endotherapy (ET), result and complications of 97 patients with SNADA.

	Total n = 97	Snare polypectomy n = 39	EMR n = 33	EBL n = 11	Endoloop n = 6	EMR + EBL n = 7	EMR + endoloop n = 1
Procedure time, min; mean (SD)	25 (12)	26 (10)	28 (15)	14 (5)	23 (11)	24 (9)	25
<10 mm	7 (7)	3 (8)	4 (15)	0	0	0	0
10–19 mm	49 (51)	20 (51)	19 (55)	8 (72)	1 (17)	1 (14)	0
≥ 20 mm	41 (42)	16 (41)	10 (30)	3 (27)	5 (83)	6 (86)	1 (100)
Prophylactic haemostasis	10 (10)	9 (23)	1 (3)	0	0	0	0
Haemostasis for periprocedural bleeding	17 (17)	9 (23)	8 (24)	0	0	0	0
‘successful resection’	82 (85)	33 (85)	31 (32)	9 (82)	4 (67)	4 (57)	1 (100)
En bloc	36 (37)	12 (31)	16 (49)	4 (36)	4 (67)	0	0
Piecemeal	61 (63)	27 (69)	17 (52)	7 (64)	2 (33)	7 (100)	1 (100)
ET for residual	23 (24)	5 (13)	8 (24)	4 (36)	3 (50)	3 (43)	0
ET for recurrence	16 (17)	10 (26)	3 (9)	1 (9)	0	2 (29)	0
ET final success	86 (89)	36 (92)	31 (94)	10 (91)	5 (83)	3 (43)	1 (100)
ET final failure	11 (11)	3 (8)	2 (6)	1 (9)	1 (17)	4 (57)	0
Surgery	4 (5)	1 (3)	0	0	0	3 (43)	0
Complication	11 (11)	6 (15)	4 (12)	1 (9)	0	0	0
Perforation	1	0	1	0	0	0	0
Septicaemia	1	0	1	0	0	0	0
Bleeding	7	4	2	1	0	0	0
Cardiac arrest	1	1	0	0	0	0	0
Myocardial infarction	1	1	0	0	0	0	0

Table 4. Histology in diagnostic gastroscopy and after endoscopic therapy.

Diagnostic gastroscopy		After the first endoscopic therapy
Tubular adenoma	82 (85%)	Tubular adenoma	68 (70%)
Tubulovillous adenoma	13 (13%)	Tubulovillous adenoma	9 (9%)
Pyloric gland adenoma	1 (1%)	Pyloric gland adenoma	1
No biopsy, CT	1	Lack of polyp tissue retrieval^a	19 (20%)
Low-grade dysplasia	76 (78%)	Low-grade dysplasia	53 (69%)
High-grade dysplasia	19 (20%)	High-grade dysplasia	24 (31%)
Not available, not defined	2	–	–

^aNo biopsy, endoscopic band ligation and lack of polyp tissue retrieval (n = 12); samples lost with peristalsis (n = 7).

Table 5. Patients with a final failure of endoscopic therapy.

Sex/age	ASA	Anaemia or GI bleeding	Oral anticoagulant	≥ 2 cm adenoma	Highest dysplasia	Surgery	Death
M/54	3	Yes	Yes	No	HG	Yes	Yes
F/74	3	No	No	Yes	HG	Yes	No
M/67	4	Yes	Yes	Yes	HG	Yes	No
F/75	3	No	No	Yes	LG	Yes	No
M/75	3	Yes	No	Yes	HG	No	No
F/67	4	Yes	Yes	No	LG	No	Yes
M/59	4	No	Yes	Yes	LG	No	Yes
M/69	3	Yes	No	Yes	LG	No	Yes
F/89	4	Yes	No	Yes	LG	No	Yes
M/75	4	Yes	Yes	No	LG	No	No
F/82	2	Yes	No	Yes	LG	No	No

ASA: American Society of Anaesthesiologists classification; GI: gastrointestinal; HG: high grade; LG: low grade

Table 6. Results of endoscopic therapy (success rate, recurrence, and complications) of sporadic non-ampullary duodenal adenomas in different studies.

Country, year (ref)	Patients/ lesions	Follow-up in months	Success rate (%)	Residual or recurrence rate (%)	Failure (%)**	Bleeding (%)	Perforation (%)
France, 2021 [18]	130	25, median	96	29	4	13	4
Japan, 2015 [21]	113/121 EMR 87% ESD 7%	51, median 1-year follow-up: n = 76	100	0	0	12 0	0 25
Switzerland, 2017 [22]	78	33, mean follow-up in 64 patients	91	9/0	1.3	9	3
USA, 2018 [23]	142/142	12, median	92	23	0	11	0
USA, 2015 [24]	10/10	24	100	50*/0	0	0	0
Japan, 2021 [25]	144	12	97	3	0	1	0
Germany, 2020 [8]	110/118 89 + 29 ampullary adenomas	na	94	20*	0	19	4
Japan, 2019 [27]	131/147 EMR93% ESD 7%	43, median	R0: 68 73	3 0	0	0 27	45
Korea, 2020 [28]	92 APC26% EMR62% ESD12%	19, median	80	1	0		5 46
Italy, 2018 [19]	68, F-U 61	59, median	98	10.9 14.5*	1.5	17	4
USA, 2017 [26]	49/49	17, median	91	0	0	5	2
Finland, this study	97	23, median	89	24* and 17	11	7	1

*Residual at first control; **failure: failure to treat residual or recurrence with endotherapy.

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