Table 4.
Endoscopic treatment for duodenal neoplastic lesions
| Author | Treatment | Follow up | Patients | Outcome | Postoperative |
| Soravia52 | Endoscopic resection nos | 4–34 months &;(mean 18) | 6 FAP | Recurrence of duodenal adenomas in all 5 surviving patients | 1 patient died of acute pancreatitis after endoscopic ampullectomy |
| Bertoni53 | Snare papillectomy | 18 months | 2 FAP | Recurrence in 1 patient, successfully retreated | 1 oozing-type haemorrhage and 1 mild pancreatitis, controlled by conservative measures |
| Morpurgo44 | Snare polypectomy (3) argon plasma therapy (2) | 6–24 months &;(mean 19) | 5 FAP | Recurrence in 3 patients | No postoperative complications |
| Alarcon46 | Snare polypectomy and thermal contact ablation | 14–83 months &;(mean 43.5) | 3 FAP | Recurrence in 3 patients | NS |
| Heiskanen5 | Snare excision (5), YAG laser coagulation (1) | 0.4–15.1 years &;(median 6.8) | 6 FAP | No significant difference in Spigelman stage preoperative and at latest endoscopy | Patient treated with YAG laser developed mild pancreatitis |
| Norton54 | Ampullary ablative therapy | 1–134 months &;(median 24) | 59 FAP, 32 sporadic | Return to normal histology in 44% of sporadic and 34% of FAP lesions | 12 patients had mild complications, 3 severe complications: 1 duodenal stenosis, 1 postcoagulation syndrome, 1 necrotising pancreatitis |
| Norton55 | Snare excision of papilla | 2–32 months &;(median 9) | 15 FAP, 11 sporadic | Recurrence rate of adenomatous tissue of 10% | 2 minor bleedings, 4 mild pancreatitis, 1 duodenal perforation |
| Mlkvy49 | PDT with ALA or Photofrin | 4 FAP patients with duodenal polyps | Superficial necrosis and no polyp reduction after PTD with ALA. Deep necrosis and moderate polyp reduction after PDT using Photofrin. | Mild skin photosensitivity using Photofrin | |
| Regula48 | PDT with ALA | 2 duodenal adenomas, 3 ampullary carcinomas | Superficial necrosis of adenomas and in 2 adenocarcinomas. 1 adenocarcinoma unaffected. | Side effects included mild skin photosensitivity, nausea/vomiting, and transient increases in ASAT | |
| Loh50 | PDT with HpD or Photofrin | 3–50 months &;(median 5.5) | 8 patients with 9 colorectal adenomas | 7 adenomas successfully eradicated | No local complications |
| Abulafi51 | PDT with HpD | 10 patients with ampullary carcinoma unsuitable for surgery | Remission for 8–12 months in 3 patients with small tumours. In 4 patients with small tumours bulk was reduced. No improvement in patients with extensive disease | 3 patients with moderate skin sensitisation |
NS, not stated; PDT, photodynamic therapy; ALA, 5-aminolaevulinic acid; HpD, haematoporphyrin derivate or Photofrin; FAP, familial adenomatous polyposis.