Updates in endoscopic management of ampullary and duodenal adenomas

Curr Opin Gastroenterol. 2023 Nov 1;39(6):496-502. doi: 10.1097/MOG.0000000000000976. Epub 2023 Oct 5.

Abstract

Purpose of review: Adenomas are the most common benign lesions of the gastrointestinal tract. The current review aims to summarize recent literature regarding risk factors, natural history, diagnostic and staging technique, and management strategies for ampullary and nonampullary duodenal adenomas.

Recent findings: Recent studies identified several possible risks factors for duodenal adenomas (e.g., cholecystectomy, proton pump inhibitor use), although these associations require corroboration. Chromoendoscopy and endocystoscopy may offer accuracy comparable to biopsies in expert hands. Recent publications underscore the reduction in morbidity with endoscopic resection for lesions without signs of malignancy with submucosal invasion. Submucosal injection did not improve safety of endoscopic ampullectomy.

Summary: Surveillance may be a reasonable strategy for sub-centimeter ampullary adenomas occurring in familial adenomatous polyposis, as they carry a relatively low risk of malignancy. Endoscopic resection is the preferred strategy over surgery in patients without lesions suggestive of invasive malignancy. For nonampullary duodenal adenomas, several endoscopic resection techniques are available, each with their unique advantages and trade-offs. In patients who are not operative candidates but have intraductal extension, endoscopic ablation is an emerging option.

Publication types

  • Review

MeSH terms

  • Adenoma* / diagnosis
  • Adenomatous Polyposis Coli* / surgery
  • Duodenal Neoplasms* / diagnosis
  • Duodenal Neoplasms* / pathology
  • Duodenal Neoplasms* / surgery
  • Endoscopy
  • Humans
  • Retrospective Studies
  • Risk Factors