title: Nonampullary duodenal adenoma: Current understanding of its diagnosis, pathogenesis, and clinical management.
abstract: Nonampullary duodenal adenomas are relatively common in familial adenomatous polyposis (FAP), but nonampullary sporadic duodenal adenomas (SDAs) are rare. Emerging evidence shows that duodenal adenomas, regardless of their anatomic location and whether they are sporadic or FAP-related, share morphologic and molecular features with colorectal adenomas. The available data suggest that duodenal adenomas develop to duodenal adenocarcinomas via similar mechanisms. The optimal approach for management of duodenal adenomas remains to be determined. The techniques for endoscopic resection of duodenal adenoma include snare polypectomy, endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and argon plasma coagulation ablation. EMR may facilitate removal of large duodenal polyps. Although several studies have reported cases of successful ESD for duodenal adenomas, the procedure is technically difficult to perform safely because of the anatomical properties of the duodenum. Although current clinical practice recommends endoscopic resection of all large duodenal adenomas in patients with FAP, endoscopic treatment is usually insufficient to guarantee a polyp-free duodenum. Surgery is indicated for FAP patients with severe polyposis or nonampullary SDAs or FAP-related polyps not amenable to endoscopic resection. Further studies are needed to develop newer endoscopic techniques to guide diagnostic and therapeutic decisions for future management of nonampullary duodenal adenomas.
authors.affiliation: Chul-Hyun Lim, Young-Seok Cho, Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea.
authors.forename: Chul-Hyun
authors.initials: CH
authors.lastname: Lim
authors.affiliation: Chul-Hyun Lim, Young-Seok Cho, Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, South Korea.
authors.forename: Young-Seok
authors.initials: YS
authors.lastname: Cho
mesh_terms: D018256:Adenomatous Polyps / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D004210:Dissection / Q000009:adverse effects / Q000379:methods*; D004379:Duodenal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D004384:Duodenoscopy / Q000009:adverse effects; D006801:Humans; D007417:Intestinal Polyps / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology; D011237:Predictive Value of Tests; D016896:Treatment Outcome
keywords: Duodenal adenoma; Endoscopic mucosal resection; Endoscopic submucosal dissection; Endoscopy; Familial adenomatous polyposis
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