Duodenal Adenomas: Clinical, Endoscopic, and Histopathologic Characteristics in 1,132 Patients.
Jennifer M Hurrell, Robert M Genta. Caris Life Sciences, Irving, TX; UT Southwestern and Dallas VA Medical Center, TX
Background: Duodenal adenomas (DA) are relatively rare lesions, with a reported prevalence of <0.4%. With small numbers available for study in each series, potentially useful associations may escape detection. The purpose of this study was to evaluate the demographic, clinical, endoscopic, and histopathologic characteristics of an unusually large series of adenomatous lesions of the duodenum.
Design: Using an electronic database we extracted demographic, clinical, endoscopic, and histopathologic data from patients who had duodenal biopsies submitted to a national pathology laboratory from 1/2008 to 8/2010. Data from patients with the histopathologic diagnosis of duodenal adenoma were compared to patients without duodenal adenoma. The characteristics of concurrent gastric, small intestinal, and colonic biopsies were also analyzed when available.
Results: There were duodenal biopsies from 148,245 patients with (median age 53 years, 34% male); 1,132 patients (0.8%) had a histopathologic diagnosis of duodenal adenoma (median age 67; 47% male; OR 1.69 1.50-1.90; p<0.0001); 24 DAs (2.1%) had high grade dysplasia. There were also 4 duodenal adenocarcinomas, not included in this analysis. Amongst patients with DA, 77 (6.8%%) were identified as having one of the familial polyposis syndromes. The main indications for endoscopy (GERD, pain, and anemia) were not different for patients with and without DA. An endoscopic impression of a polyp or nodule was reported in virtually all patients. Concurrent gastric biopsies were available from 607 DA patients and 106,007 non-DA patients: amongst non-polyposis patients, funding gland polyps were almost 3 times as common in patients with DA than in those without (OR 2.62 95%CI 2.08-3.33; p<0.0001). Amongst the 33,355 patients who had a simultaneous colonoscopy, 61.3% of non-polyposis patients with DA had colonic adenomas, in contrast to 29.1% of those without DA (OR 4.34 95%CI 3.23-5.84; p<0.0001).
Conclusions: In our series DAs had a higher prevalence (0.8%) than previously reported. They occurred mostly in the 6th and 7th decade, with a distinct male predominance. Virtually all DAs were discovered incidentally during esophagogastroduodenoscopy performed mostly for GERD or dyspepsia. A nodule was seen endoscopically in almost every case. Even in patients with no known polyposis syndromes there was a strong association with gastric fundic gland polyps and colonic adenomas, raising the possibility that some DA patients have unrecognized polyposis syndromes.
Tuesday, March 1, 2011 1:00 PM
Poster Session IV # 61, Tuesday Afternoon