Sporadic non-ampullary duodenal adenoma with low-grade dysplasia: Natural history and clinical management.
Endosc Int Open
; 10(3): E254-E261, 2022 Mar.
Article
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| MEDLINE
| ID: mdl-35295245
ABSTRACT
Background and study aims Management strategies for sporadic non-ampullary duodenal adenoma with low-grade dysplasia (LGD) are not well established. This study aimed to analyze progression factors and determine suitable treatment strategies for LGD lesions. Patients and methods We retrospectively analyzed consecutive LGD lesions (nâ=â125) in patients followed up for ≥â6 months (median, 45 months) and evaluated the changes in clinicopathological features during follow-up.âAll LGD lesions were classified into two groups stable LGD (no increase orâ<â5âmm increase in tumor size, with unchanged histological dysplasia grade) and progressive LGD (≥â5âmm increase in tumor size and/or progression to high-grade dysplasia or adenocarcinoma). Results Eighty-six LGD were classified as stable and 39 as progressive. Location on the oral side of the papilla of Vater, large initial tumor size (â≥â10âmm), macroscopically complex type, red color, and nodularity were significantly frequent in progressive LGD than in stable LGD. In multivariate analysis, large initial tumor size (odds ratio [OR], 10.2; 95â% confidence interval [CI], 3.3-32.1; P â<â0.001) and location on the oral side of the papilla of Vater (OR 1.8, 95â% CI 1.4-12.5; P â=â0.012) were significant factors for progression. Moreover, initial tumor sizeâ<â5âmm rarely progressed (0%-3.9â%); however, initial tumor sizeâ≥â20âmm and 10-19âmm located on the oral side of the papilla of Vater had a high-risk progression rate (75.0-85.7â%). Conclusions According to the risk stratification of progression factors by initial tumor size and location, we can determine suitable treatment indications for LGD lesions.
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MEDLINE
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Endosc Int Open
Año:
2022
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Article
País de afiliación:
Japón