Skip to main content
SpringerLink
Log in

Prospective study of acute complication rates and associated risk factors in endoscopic therapy for duodenal adenomas

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Endoscopic therapy for duodenal adenomas is becoming increasingly important. However, only a few studies have been published on the topic, mainly with retrospective data.

Methods

This prospective study was carried out to determine complication rates and associated risk factors during and after endoscopic therapy for duodenal adenomas. Between May 2011 and October 2012, 50 patients (with 61 duodenal adenomas) were included. Sixty-one duodenal adenomas were resected endoscopically. Complications (e.g., bleeding, pain, fever, pancreatitis, and perforation) were recorded. Associations between bleeding and other factors—sex, age, anticoagulation, location and size of adenomas, etiology, lesion morphology, resection type, and argon plasma coagulation (APC) for bleeding prophylaxis—were then investigated.

Results

Bleeding was the main complication. Major bleeding occurred in four cases (6.5 %) and minor bleeding in 11 (18 %). One occult perforation also occurred. There was a statistically significant association between bleeding and the size of the adenoma (P = 0.012). APC for bleeding prophylaxis showed a promising trend, with an odds ratio of 0.31, reducing the bleeding risk by two-thirds in this study. However, due to the small number of six patients that received bleeding prophylaxis with APC therapy, this result was not statistically significant (P = 0.31).

Conclusions

Bleeding is the main complication in endoscopic therapy for duodenal adenomas. The bleeding risk increases significantly with adenoma size. Prophylactic APC seems to reduce the bleeding rate—however, because of the relatively small number of patients treated with APC, this partial result was not statistically relevant. Due to the relevant rate of complications, endoscopic resection of duodenal adenomas is only recommended in an in-patient setting.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

APC:

Argon plasma coagulation

EGD:

Esophagogastroduodenoscopy

ER:

Endoscopic resection

EUS:

Endoscopic ultrasound

GEE:

General Estimating Equations

FAP:

Familial adenomatous polyposis

FICE:

Fuji Intelligent Chromo Endoscopy

HGIN:

High-grade intraepithelial neoplasia

INR:

International normalized ratio

MAP:

MYH-associated polyposis

NAD:

lesions Nonampullary duodenal lesions

OTSC:

Over the scope clip

PPPD:

Pylorus-preserving pancreatoduodenectomy

PSD:

Pancreas-sparing duodenectomy

SD:

Standard deviation

Y:

Years

References

  1. Sato T, Konishi K, Kimura H et al (1999) Adenoma and tiny carcinoma in adenoma of the papilla of Vater—p53 and PCNA. Hepatogastroenterology 46:1959–1962

    CAS  PubMed  Google Scholar 

  2. Seifert E, Schulte F, Stolte M (1992) Adenoma and carcinoma of the duodenum and papilla of Vater: a clinicopathologic study. Am J Gastroenterol 87:37–42

    CAS  PubMed  Google Scholar 

  3. Spigelman AD, Williams CB, Talbot IC et al (1989) Upper gastrointestinal cancer in patients with familial adenomatous polyposis. Lancet 2(8666):783–785

    Article  CAS  PubMed  Google Scholar 

  4. Standards of Practice Committee, Adler DG, Qureshi W, et al. (2006) The role of endoscopy in ampullary and duodenal adenomas. Gastrointest Endosc 64:849–54

  5. Alexander S, Bourke MJ, Williams SJ et al (2009) EMR of large, sessile, sporadic nonampullary duodenal adenomas: technical aspects and long-term outcome (with videos). Gastrointest Endosc 69:66–73

    Article  PubMed  Google Scholar 

  6. Ahmad NA, Kochman ML, Long WB et al (2002) Efficacy, safety, and clinical outcomes of endoscopic mucosal resection: a study of 101 cases. Gastrointest Endosc 55:390–396

    Article  PubMed  Google Scholar 

  7. Oka S, Tanaka S, Nagata S et al (2003) Clinicopathologic features and endoscopic resection of early primary nonampullary duodenal carcinoma. J Clin Gastroenterol 37:381–386

    Article  PubMed  Google Scholar 

  8. Swan MP, Bourke MJ, Alexander S et al (2009) Large refractory colonic polyps: is it time to change our practice? A prospective study of the clinical and economic impact of a tertiary referral colonoscopic polypectomy service. Gastrointest Endosc 70:1128–1136

    Article  PubMed  Google Scholar 

  9. Bourke MJ (2011) Endoscopic mucosal resection in the colon: a practical guide. Tech Gastrointest Endosc 13:35–49

    Article  Google Scholar 

  10. Lépilliez V, Chemaly M, Ponchon T et al (2008) Endoscopic resection of sporadic duodenal adenomas: an efficient technique with a substantial risk of delayed bleeding. Endoscopy 40:806–810

    Article  PubMed  Google Scholar 

  11. Apel D, Jakobs R, Spiethoff A et al (2005) Follow-up after endoscopic snare resection of duodenal adenomas. Endoscopy 37:444–448

    Article  CAS  PubMed  Google Scholar 

  12. Jepsen JM, Persson M, Jakobsen NO et al (1994) Prospective study of prevalence and endoscopic and histopathologic characteristics of duodenal polyps in patients submitted to upper endoscopy. Scand J Gastroenterol 29:483–487

    Article  CAS  PubMed  Google Scholar 

  13. Bülow S, Björk J, Christensen IJ et al (2004) Duodenal adenomatosis in familial adenomatous polyposis. Gut 53:381–386

    Article  PubMed Central  PubMed  Google Scholar 

  14. Jagelman DG, DeCosse JJ, Bussey HJ (1988) Upper gastrointestinal cancer in familial adenomatous polyposis. Lancet 1(8595):1149–1151

    Article  CAS  PubMed  Google Scholar 

  15. Vasen HF, Bülow S, Myrhøj T et al (1997) Decision analysis in the management of duodenal adenomatosis in familial adenomatous polyposis. Gut 40:716–719

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Offerhaus GJ, Giardiello FM, Krush AJ et al (1992) The risk of upper gastrointestinal cancer in familial adenomatous polyposis. Gastroenterology 102:1980–1982

    CAS  PubMed  Google Scholar 

  17. van Heumen BW, Nieuwenhuis MH, van Goor H et al (2012) Surgical management for advanced duodenal adenomatosis and duodenal cancer in Dutch patients with familial adenomatous polyposis: a nationwide retrospective cohort study. Surgery 151:681–690

    Article  PubMed  Google Scholar 

  18. Birkmeyer JD, Siewers AE, Finlayson EV et al (2002) Hospital volume and surgical mortality in the United States. N Engl J Med 346:1128–1137

    Article  PubMed  Google Scholar 

  19. Farnell MB, Sakorafas GH, Sarr MG et al (2000) Villous tumors of the duodenum: reappraisal of local vs. extended resection. J Gastrointest Surg 4:13–23

    Article  CAS  PubMed  Google Scholar 

  20. Krukowski ZH, Ewen SW, Davidson AI et al (1988) Operative management of tubulovillous neoplasms of the duodenum and ampulla. Br J Surg 75:150–153

    Article  CAS  PubMed  Google Scholar 

  21. de Castro SM, van Eijck CH, Rutten JP et al (2008) Pancreas-preserving total duodenectomy versus standard pancreatoduodenectomy for patients with familial adenomatous polyposis and polyps in the duodenum. Br J Surg 95:1380–1386

    Article  PubMed  Google Scholar 

  22. Mackey R, Walsh RM, Chung R et al (2005) Pancreas-sparing duodenectomy is effective management for familial adenomatous polyposis. J Gastrointest Surg 9:1088–1093

    Article  PubMed  Google Scholar 

  23. Lepistö A, Kiviluoto T, Halttunen J et al (2009) Surveillance and treatment of duodenal adenomatosis in familial adenomatous polyposis. Endoscopy 41:504–509

    Article  PubMed  Google Scholar 

  24. Gallagher MC, Shankar A, Groves CJ et al (2004) Pylorus-preserving pancreaticoduodenectomy for advanced duodenal disease in familial adenomatous polyposis. Br J Surg 91:1157–1164

    Article  CAS  PubMed  Google Scholar 

  25. Ponchon T (2001) Endoscopic mucosal resection. J Clin Gastroenterol 32:6–10

    Article  CAS  PubMed  Google Scholar 

  26. Haubrich WS, Johnson RB, Foroozan P (1973) Endoscopic removal of a duodenal adenoma. Gastrointest Endosc 19:201

    Article  CAS  PubMed  Google Scholar 

  27. Abbass R, Rigaux J, Al-Kawas FH (2010) Nonampullary duodenal polyps: characteristics and endoscopic management. Gastrointest Endosc 71:754–759

    Article  PubMed  Google Scholar 

  28. Kedia P, Brensinger C, Ginsberg G (2010) Endoscopic predictors of successful endoluminal eradication in sporadic duodenal adenomas and its acute complications. Gastrointest Endosc 72:1297–1301

    Article  PubMed  Google Scholar 

  29. Sohn JW, Jeon SW, Cho CM et al (2010) Endoscopic resection of duodenal neoplasms: a single-center study. Surg Endosc 24:3195–3200

    Article  PubMed  Google Scholar 

  30. Jaganmohan S, Lynch PM, Raju RP et al (2012) Endoscopic management of duodenal adenomas in familial adenomatous polyposis—a single-center experience. Dig Dis Sci 57:732–737

    Article  PubMed  Google Scholar 

  31. Saurin JC, Chavaillon A, Napoléon B et al (2003) Long-term follow-up of patients with endoscopic treatment of sporadic adenomas of the papilla of Vater. Endoscopy 35:402–406

    Article  PubMed  Google Scholar 

  32. Catalano MF, Linder JD, Chak A et al (2004) Endoscopic management of adenoma of the major duodenal papilla. Gastrointest Endosc 59:225-2

    Google Scholar 

  33. Kim HK, Chung WC, Lee BI et al (2010) Efficacy and long-term outcome of endoscopic treatment of sporadic nonampullary duodenal adenoma. Gut Liver 4:373–377

    Article  PubMed Central  PubMed  Google Scholar 

  34. König J, Kaiser A, Opfermann P, et al (2014) Acute complications after endoscopic resection of duodenal adenomas. Z Gastroenterol 52:187–192

  35. Fanning SB, Bourke MJ, Williams SJ et al (2012) Giant laterally spreading tumors of the duodenum: endoscopic resection outcomes, limitations, and caveats. Gastrointest Endosc 75:805–812

    Article  PubMed  Google Scholar 

  36. Binmoeller KF, Shah JN, Bhat YM et al (2013) “Underwater” EMR of sporadic laterally spreading nonampullary duodenal adenomas (with video). Gastrointest Endosc 78:496–502

    Article  PubMed  Google Scholar 

  37. Shiba M, Higuchi K, Kadouchi K et al (2005) Risk factors for bleeding after endoscopic mucosal resection. World J Gastroenterol 11:7335–7339

    PubMed  Google Scholar 

  38. Lienert A, Bagshaw PF (2007) Treatment of duodenal adenomas with endoscopic argon plasma coagulation. ANZ J Surg 77:371–373

    Article  PubMed  Google Scholar 

  39. Manner H, May A, Rabenstein T et al (2007) Prospective evaluation of a new high-power argon plasma coagulation system (hp-APC) in therapeutic gastrointestinal endoscopy. Scand J Gastroenterol 42:397–405

    Article  PubMed  Google Scholar 

  40. Moss A, Bourke MJ, Williams SJ et al (2011) Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia. Gastroenterology 140:1909–1918

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We are grateful to Prof. Manfred Berres for statistical support and to Michael Robertson for revising the manuscript.

Disclosure

Financial support and potential competing interests: Andrea May, Jürgen Pohl, and Christian Ell have received speakers’ honoraria from Fujifilm, Inc. Insa Aschmoneit-Messer and Johannes Richl have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Internal Medicine II, HSK Wiesbaden (Teaching Hospital of the University of Mainz), Ludwig-Erhard-Strasse 100, 65199, Wiesbaden, Germany

    Insa Aschmoneit-Messer & Johannes Richl

  2. Department of Medicine 2, Sanaklinikum Offenbach (Teaching Hospital of the University of Frankfurt), Offenbach, Germany

    Christian Ell & Andrea May

  3. Department of Internal Medicine, Vivantes Klinikum im Friedrichshain, Berlin, Germany

    Jürgen Pohl

Authors
  1. Insa Aschmoneit-Messer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Johannes Richl
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jürgen Pohl
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christian Ell
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrea May
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Insa Aschmoneit-Messer.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Aschmoneit-Messer, I., Richl, J., Pohl, J. et al. Prospective study of acute complication rates and associated risk factors in endoscopic therapy for duodenal adenomas. Surg Endosc 29, 1823–1830 (2015). https://doi.org/10.1007/s00464-014-3871-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-014-3871-5

Keywords

Search

Navigation