Post written by Grace E. Kim, MD, from the Section of Gastroenterology, Hepatology, and Nutrition, and Uzma D. Siddiqui, MD, from the Center for Endoscopic Research and Therapeutics, University of Chicago, Chicago, Illinois, USA.

This instructional video reviews the management of duodenal polyps, including sporadic duodenal and ampullary adenomas.

Although these are typically benign lesions, they have malignant potential and, therefore, removal is suggested. Our video highlights some of the commonly used techniques for endoscopic resection, including EMR and ampullectomy, and their potential associated adverse events.

Duodenal polyps are rare but increasingly found incidentally on upper endoscopy. It is important to determine which type of polyp (eg, sporadic duodenal adenoma, familial adenomatous polyposis—associated adenoma, ampullary adenoma) you are dealing with to determine the best management. Polyp resection in the duodenum is more challenging than the colon because of its thin wall, increased motility, smaller lumen size, and rich vascular supply.

Furthermore, even after resection, caustic bile and proteolytic enzymes flowing through the lumen could prevent or disrupt wound healing. These can lead to higher rates of bleeding and perforation. Ampullectomies carry the additional risk of pancreatitis, and it is essential to place a pancreatic duct stent afterward to minimize this.

Our video provides a comprehensive overview of duodenal and ampullary adenomas, including their endoscopic management techniques, potential adverse events, and surveillance plan. We hope that viewers can become more familiar with duodenal and ampullary adenomas.

We also want to raise awareness of the risks of performing duodenal and ampullary endoscopic resections and help viewers better understand various endoscopic techniques using different devices and scopes to achieve successful removal.

Duodenal adenomas before (A and B) and after (C and D) EMR in piecemeal fashion with hemostatic powder applied at the end.

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.