title: Endoluminal ultrasound of neoduodenum following pancreas-preserving total duodenectomy for familial adenomatous polyposis.
abstract: BACKGROUND
  Familial adenomatous polyposis affects around 2-10 per 100,000 population. Untreated, it inevitably leads to colon cancer. Prophylactic panproctocolectomy has led to improved survival. The resulting extension to follow-up has revealed that 70-100% of patients with familial adenomatous polyposis go on to develop duodenal polyposis and the lifetime risk of duodenal carcinoma in this group is up to 10%. Treatment for those not locally resectable requires pancreaticoduodenectomy. In recent years, pancreas-preserving total duodenectomy has emerged as a safe alternative to pancreaticoduodenectomy. Endoscopy has previously been safely performed in patients following pancreas-preserving total duodenectomy.
  
  
  METHODS
  We report successful endoscopic ultrasound (EUS) assessment and trans-neoduodenal EUS-guided fine needle aspiration biopsy (EUS-FNA) of the pancreas and adjacent tissue in a 45-year-old man with familial adenomatous polyposis who has previously undergone pancreas-preserving total duodenectomy. EUS confirmed the mass was most likely to represent a metastasis in a local lymph node. EUS-FNA confirmed invasive malignancy. A Kausch-Whipple pancreaticoduodenectomy was performed successfully and post-operative recovery has been excellent.
  
  
  CONCLUSIONS
  The authors consider this to be the first report of successful EUS and EUS-FNA performed through the neoduodenum fashioned during pancreas-preserving total duodenectomy.
authors.affiliation: Department of General Surgery, Morriston Hospital, ABM University Health Board, Swansea, UK.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Beamish
authors.forename: S Ashley
authors.initials: SA
authors.lastname: Roberts
authors.forename: James
authors.initials: J
authors.lastname: Ansell
authors.forename: Bilal
authors.initials: B
authors.lastname: Al-Sarireh
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000473:pathology* / Q000601:surgery*; D044963:Biopsy, Fine-Needle / Q000379:methods*; D004386:Duodenum / Q000601:surgery*; D019160:Endosonography; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology* / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000379:methods; D016896:Treatment Outcome