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Feasibility of endoscopic resection using bipolar snare for nonampullary duodenal tumours in familial adenomatous polyposis patients

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Abstract

The management of duodenal and colorectal tumours is important in patients with familial adenomatous polyposis (FAP). Endoscopic resection (ER) should be carefully performed because the risk of complications during or after (ER) of nonampullary duodenal tumours is higher than that of stomach or colorectal lesions in general. Thus, we evaluated the feasibility of endoscopic resection using bipolar snare (ERB) for nonampullary duodenal tumours in FAP patients. Eleven FAP patients who underwent ERB for nonampullary duodenal tumours at our hospital between October 2013 and December 2016 were retrospectively analysed based on clinicopathological features. ER was generally indicated for endoscopically diagnosed tumours > 20 mm, biopsy-confirmed high-grade dysplasia or carcinomas > 10 mm, and multiple tumours. Nineteen endoscopic treatments were performed and 134 nonampullary duodenal tumours were resected. The median patient age at initial treatment was 40 years (range 20–64), and median size of the largest tumour in each procedure was 16 mm (range 9–40). Of the 101 pathologically evaluated lesions, 10 tumours were high-grade tubular adenomas, 87 were low-grade tubular adenomas, 1 was an adenocarcinoma, and 3 were non-neoplastic mucosal polyps. No intraoperative or delayed perforations were observed. Melena was encountered in one patient and managed without emergent endoscopic intervention. ERB for nonampullary duodenal tumours of FAP patients is feasible and effective, even for large lesions with high-grade dysplasia. Long-term outcomes of ERB, including local recurrence and prognosis, should be monitored.

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References

  1. Moozar KL, Madlensky L, Berk T, Gallinger S (2002) Slow progression of periampullary neoplasia in familial adenomatous polyposis. J Gastrointest Surg 6(6):831–837 (discussion 7)

    Article  Google Scholar 

  2. Brosens LAA, Keller JJ, Offerhaus GJA, Goggins M, Giardiello FM (2005) Prevention and management of duodenal polyps in familial adenomatous polyposis. Gut 54(7):1034–1043. https://doi.org/10.1136/gut.2004.053843

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Belchetz LA, Berk T, Bapat BV, Cohen Z, Gallinger S (1996) Changing causes of mortality in patients with familial adenomatous polyposis. Dis Colon Rectum 39(4):384–387

    Article  CAS  Google Scholar 

  4. Spigelman AD, Williams CB, Talbot IC, Domizio P, Phillips RK (1989) Upper gastrointestinal cancer in patients with familial adenomatous polyposis. Lancet 2(8666):783–785

    Article  CAS  Google Scholar 

  5. Brosens LA, Keller JJ, Offerhaus GJ, Goggins M, Giardiello FM (2005) Prevention and management of duodenal polyps in familial adenomatous polyposis. Gut 54(7):1034–1043. https://doi.org/10.1136/gut.2004.053843

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Yachida T, Nakajima T, Nonaka S et al (2016) Characteristics and clinical outcomes of duodenal neoplasia in Japanese patients with familial adenomatous polyposis. J Clin Gastroenterol. https://doi.org/10.1097/mcg.0000000000000555

    Article  PubMed  Google Scholar 

  7. Provenzale D, Gupta S, Ahnen DJ et al (2016) Genetic/familial high-risk assessment: colorectal version 1.2016, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 14(8):1010–1030

    Article  CAS  Google Scholar 

  8. Morpurgo E, Vitale GC, Galandiuk S, Kimberling J, Ziegler C, Polk HC Jr (2004) Clinical characteristics of familial adenomatous polyposis and management of duodenal adenomas. J Gastrointest Surg 8(5):559–564. https://doi.org/10.1016/j.gassur.2004.03.001

    Article  PubMed  Google Scholar 

  9. Moussata D, Napoleon B, Lepilliez V et al (2014) Endoscopic treatment of severe duodenal polyposis as an alternative to surgery for patients with familial adenomatous polyposis. Gastrointest Endosc 80(5):817–825. https://doi.org/10.1016/j.gie.2014.03.012

    Article  PubMed  Google Scholar 

  10. Nonaka S, Oda I, Tada K et al (2015) Clinical outcome of endoscopic resection for nonampullary duodenal tumors. Endoscopy 47(2):129–135. https://doi.org/10.1055/s-0034-1390774

    Article  PubMed  Google Scholar 

  11. Lepilliez V, Chemaly M, Ponchon T, Napoleon B, Saurin JC (2008) Endoscopic resection of sporadic duodenal adenomas: an efficient technique with a substantial risk of delayed bleeding. Endoscopy 40(10):806–810. 10.1055/s-2008-1077619

    Article  CAS  PubMed  Google Scholar 

  12. Ishikawa H, Mutoh M, Iwama T et al (2016) Endoscopic management of familial adenomatous polyposis in patients refusing colectomy. Endoscopy 48(1):51–55. https://doi.org/10.1055/s-0034-1392774

    Article  PubMed  Google Scholar 

  13. Nonaka S, Saito Y, Fukunaga S, Sakamoto T, Nakajima T, Matsuda T (2012) Impact of endoscopic submucosal dissection knife on risk of perforation with an animal model-monopolar needle knife and with a bipolar needle knife. Dig Endosc 24(5):381. https://doi.org/10.1111/j.1443-1661.2012.01249.x

    Article  PubMed  Google Scholar 

  14. Ono H, Yao K, Fujishiro M et al (2016) Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer. Dig Endosc 28(1):3–15. https://doi.org/10.1111/den.12518

    Article  PubMed  Google Scholar 

  15. Uraoka T, Ramberan H, Matsuda T, Fujii T, Yahagi N (2014) Cold polypectomy techniques for diminutive polyps in the colorectum. Dig Endosc 26(Suppl 2):98–103. https://doi.org/10.1111/den.12252

    Article  PubMed  Google Scholar 

  16. Hamada K, Takeuchi Y, Ishikawa H et al (2016) Feasibility of cold snare polypectomy for multiple duodenal adenomas in patients with familial adenomatous polyposis: a pilot study. Dig Dis Sci 61(9):2755–2759. https://doi.org/10.1007/s10620-016-4165-7

    Article  PubMed  Google Scholar 

  17. Repici A, Hassan C, Vitetta E et al (2012) Safety of cold polypectomy for < 10 mm polyps at colonoscopy: a prospective multicenter study. Endoscopy 44(1):27–31. https://doi.org/10.1055/s-0031-1291387

    Article  CAS  PubMed  Google Scholar 

  18. Raad D, Tripathi P, Cooper G, Falck-Ytter Y (2016) Role of the cold biopsy technique in diminutive and small colonic polyp removal: a systematic review and meta-analysis. Gastrointest Endosc 83(3):508–515. https://doi.org/10.1016/j.gie.2015.10.038

    Article  PubMed  Google Scholar 

  19. Matsuura N, Takeuchi Y, Yamashina T et al (2017) Incomplete resection rate of cold snare polypectomy: a prospective single-arm observational study. Endoscopy. https://doi.org/10.1055/s-0043-100215

    Article  PubMed  Google Scholar 

  20. Soravia C, Berk T, Haber G, Cohen Z, Gallinger S (1997) Management of advanced duodenal polyposis in familial adenomatous polyposis. J Gastrointest Surg 1(5):474–478

    Article  CAS  Google Scholar 

  21. Alarcon FJ, Burke CA, Church JM, van Stolk RU (1999) Familial adenomatous polyposis: efficacy of endoscopic and surgical treatment for advanced duodenal adenomas. Dis Colon Rectum 42(12):1533–1536

    Article  CAS  Google Scholar 

  22. Iida M, Aoyagi K, Fujimura Y, Matsumoto T, Hizawa K, Nakamura S (1996) Nonpolypoid adenomas of the duodenum in patients with familial adenomatous polyposis (Gardner’s syndrome). Gastrointest Endosc 44(3):305–308

    Article  CAS  Google Scholar 

  23. Groves CJ, Saunders BP, Spigelman AD, Phillips RK (2002) Duodenal cancer in patients with familial adenomatous polyposis (FAP): results of a 10 year prospective study. Gut 50(5):636–641

    Article  CAS  Google Scholar 

  24. Watanabe Y, Ishida H, Baba H et al (2017) Pancreas-sparing total duodenectomy for Spigelman stage IV duodenal polyposis associated with familial adenomatous polyposis: experience of 10 cases at a single institution. Fam Cancer 16(1):91–98. https://doi.org/10.1007/s10689-016-9932-2

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported in part by The National Cancer Center Research and Development Fund 28-A-4.

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Authors and Affiliations

  1. Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan

    Kazuya Inoki, Takeshi Nakajima, Satoru Nonaka, Seiichiro Abe, Haruhisa Suzuki, Shigetaka Yoshinaga, Ichiro Oda, Masayoshi Yamada & Yutaka Saito

  2. Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan

    Kazuya Inoki & Yuichiro Ohe

  3. Department of Genetic Medicine and Services, National Cancer Center Hospital, Tokyo, Japan

    Takeshi Nakajima & Mizuki Takatsu

  4. Pathology Division, National Cancer Center Hospital, Tokyo, Japan

    Hiroshi Yoshida, Hirokazu Taniguchi & Shigeki Sekine

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  1. Kazuya Inoki
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  2. Takeshi Nakajima
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  3. Satoru Nonaka
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  14. Yutaka Saito
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Corresponding author

Correspondence to Takeshi Nakajima.

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The author declares no conflict of interest with any individual and/or financial organization.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. We conducted this study in accordance with the guidelines of our institutional review board, which approved this retrospective study without the need for informed consent (2016-447).

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All patients provided written informed consent for ER.

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Inoki, K., Nakajima, T., Nonaka, S. et al. Feasibility of endoscopic resection using bipolar snare for nonampullary duodenal tumours in familial adenomatous polyposis patients. Familial Cancer 17, 517–524 (2018). https://doi.org/10.1007/s10689-017-0063-1

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  • DOI: https://doi.org/10.1007/s10689-017-0063-1

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