Endoscopic treatment of patients with adenomas of the major papilla of the duodenum in familial adenomatous polyposis

AIM: to evaluate the feasibility of endoscopic techniques in the treatment of patients with adenomas of the major duodenal papilla in familial adenomatous polyposis. PATIENTS AND METHODS: from January 2020 to January 2025, thirteen patients with adenomas of the major duodenal papilla (MDP) suffering from familial adenomatous polyposis (FAP) underwent endoscopic procedures. In seven cases, the adenomas of the major duodenal papilla had exclusively extrapapillary components without involvement of the ducts. Four patients presented with type IV adenomas, while two cases were classified as type III according to the endoscopic classification of benign neoplasms of the MDP. In six instances, there was noted extension of the adenoma to the common bile duct (CBD), and in three cases, the adenoma extended to the walls of the main pancreatic duct (MPD). The study examined the main aspects of MDP neoplasms, including their growth patterns and extent of spread. Additionally, the advantages of endoscopic techniques for removing these neoplasms were discussed, along with intraoperative and postoperative complications arising from the interventions. RESULTS: in all cases, endoscopic removal of adenomas of the MDP was successfully performed. It should be noted that in 7 out of 13 cases (53.8%), when neoplasms of types I and III were present, the adenomas were removed en bloc, while in 6 out of 13 cases (46.2%), fragmentary removal was performed for adenomas of types II and IV. However, complications arose in 3 out of 13 cases (23.1%) after the intervention: two patients developed moderate post-procedural pancreatitis, and one patient experienced bleeding that required endoscopic hemostasis. In 2 out of 13 cases (15.4%), residual adenoma tissue was detected, necessitating repeat endoluminal intervention. It is noteworthy that the complications (bleeding) and recurrences were managed with repeat endoscopic procedures without the need for high-trauma surgical operations. CONCLUSION: the study demonstrated the feasibility of endoscopic procedures for the treatment of patients with adenomas of the MDP against the background of FAP.