title: Endoscopic management of duodenal adenomas in familial adenomatous polyposis--a single-center experience.
abstract: BACKGROUND
  Duodenal lesions (DLS) are common in patients with familial adenomatosis polyposis (FAP), and screening for duodenal adenocarcinoma (DA) is currently recommended. Endoscopic treatment of DLS is controversial.
  
  
  OBJECTIVE
  To report management and outcomes of endoscopic therapy for DLS in patients with FAP.
  
  
  METHODS
  The records of patients with FAP who underwent endoscopic surveillance or therapy for DLS over a 15-year period were reviewed. Endoscopic intervention included endoscopic surveillance with biopsies, argon plasma coagulation (APC), endoscopic mucosal resection (EMR), EMR with APC, and ampullectomy. Main outcome measurements were recurrence and histology of DLS after endoscopic therapy, complications of endoscopic therapy, and need for duodenectomy.
  
  
  RESULTS
  Seventy-one patients with FAP and DLS were identified from our endoscopy database as undergoing upper endoscopy for screening and/or surveillance (1995-2009). Mean follow up was 4.5 years (1-15 years). Seventy of the seventy-one (98.5%) patients had multiple flat DLS. Most of the patients were followed with yearly biopsies. APC was performed in 17 patients and EMR was performed in eight patients; in five of the eight EMR patients, APC was also performed to treat the edges of EMR site. During the follow up, 17/55 (31%) patients had histological progression (HP). HP was seen in 5/16 (31%) patients who underwent APC (one was lost to follow-up) and 12/40 (30%) patients followed with biopsies alone. Recurrence of lesions was noted in all patients. Two patients underwent duodenectomy. None of the patients developed DA during follow up.
  
  
  CONCLUSIONS
  Endoscopic surveillance with directed endotherapy for DLS in FAP is feasible and safe when diligently performed.
authors.affiliation: Department of Gastroenterology, MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Sathya
authors.initials: S
authors.lastname: Jaganmohan
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Lynch
authors.forename: Ramu P
authors.initials: RP
authors.lastname: Raju
authors.forename: William A
authors.initials: WA
authors.lastname: Ross
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Lee
authors.forename: Gottumukkala S
authors.initials: GS
authors.lastname: Raju
authors.forename: Manoop S
authors.initials: MS
authors.lastname: Bhutani
authors.forename: Jason B
authors.initials: JB
authors.lastname: Fleming
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Lee
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000473:pathology* / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery; D001706:Biopsy; D015331:Cohort Studies; D004379:Duodenal Neoplasms / Q000473:pathology* / Q000601:surgery*; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D010183:Pancreatic Ducts / Q000601:surgery; D011183:Postoperative Complications; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D055815:Young Adult