title: Management of sporadic duodenal adenomas and the association with colorectal neoplasms: a retrospective cohort study.
abstract: OBJECTIVE
  To evaluate management, outcome, and follow-up of patients with sporadic duodenal adenomas and assess the presence of colorectal neoplasms.
  
  
  BACKGROUND
  With the widespread use of esophagogastroduodenoscopy, an increasing number of sporadic duodenal adenomas are diagnosed. An optimal algorithm for management has not been fully defined. Accumulating data suggest an association with colorectal neoplasms.
  
  
  METHODS
  Patients diagnosed with sporadic duodenal adenomas at our institute from 1986 until 2008 were retrospectively reviewed. Data were collected from medical records.
  
  
  RESULTS
  Fifty-four patients (28 men, 52%) were diagnosed with a sporadic duodenal adenoma at a median age of 59 years (range, 27 to 84 y); 33 patients (61%) underwent endoscopic or surgical intervention, 5 (9%) were only followed endoscopically, and 16 (30%) underwent no intervention or follow-up. Complete endoscopic removal was accomplished in at least 81% of cases, and no complications were reported; surgical intervention was complicated in 4 patients, with 1 resulting in death. Adenoma recurrence was 20% at a median follow-up of 18 months (range, 4 to 54 mo), but no carcinoma developed. Colorectal neoplasms were found in 16 of 29 patients (55%) who underwent colonoscopy, including 2 cancers (7%), 7 advanced adenomas (24%), and 7 nonadvanced adenomas (24%).
  
  
  CONCLUSIONS
  Although no consistent approach to management of sporadic duodenal adenomas was followed, no duodenal carcinoma developed during the follow-up. Endoscopic intervention is preferred over surgical intervention, whenever possible. Once complete removal is ascertained, there is no strict indication for regular follow-up esophagogastroduodenoscopy, especially in elderly patients or patients with relevant comorbidity. Colonoscopic assessment is warranted in all patients diagnosed with sporadic duodenal adenomas.
authors.affiliation: Departments of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. b.vanheumen@mdl.umcn.nl
authors.forename: Bjorn W H
authors.initials: BW
authors.lastname: van Heumen
authors.forename: Karlien
authors.initials: K
authors.lastname: Mul
authors.forename: Iris D
authors.initials: ID
authors.lastname: Nagtegaal
authors.forename: Mariëtte C A
authors.initials: MC
authors.lastname: van Kouwen
authors.forename: Fokko M
authors.initials: FM
authors.lastname: Nagengast
mesh_terms: D000236:Adenoma / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000473:pathology; D019468:Disease Management; D004379:Duodenal Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome