Nonampullary duodenal polyps: characteristics and endoscopic management

Abstract

Background: Guidelines for endoscopic resection and surveillance of nonampullary duodenal (NAD) polyps are still not well-defined.

Objective: To describe the characteristics of NAD polyps and evaluate the role of endoscopic management.

Design: Retrospective review.

Setting: Tertiary-care academic center.

Patients: This study involved 59 patients with NAD polyps.

Intervention: Endoscopic polypectomy, biopsy, and argon plasma coagulation.

Main outcome measurements: Complete polypectomy, complications, and recurrence.

Results: Ninety-six endoscopies were performed. The mean patient age was 62.8 years. The mean (+/- standard deviation) polyp size was 17.2 mm +/- 1.6 mm. The mean follow-up time was 26 months. Most lesions were sessile, solitary, and located in the descending duodenum. The procedure most often performed was submucosal injection followed by snare polypectomy. Adenomas were found in 68% of lesions overall and in 84% of lesions >2 cm. Successful resection was accomplished in 93% of cases on the initial attempt. Multiple endoscopies were needed in 5% of cases. The overall complete resection rate was 98%. Recurrence was documented in 37% of cases. Complications occurred in 5.2% of patients. Polyps of >2 cm were associated with higher rates of adenoma and a higher incidence of recurrence. Colon adenomas were found in 53% of patients with duodenal adenomas.

Limitations: Retrospective review. Not all patients underwent colonoscopy.

Conclusion: NAD polyps were large, sessile, and more commonly found in the second portion of the duodenum. They are more likely to be adenomatous when the lesion size is >2 cm. Despite successful endoscopic management, over one third of lesions demonstrated recurrence.