The prevalence of small-bowel polyps on video capsule endoscopy in patients with sporadic duodenal or ampullary adenomas

Abstract: Background and Aims Although sporadic duodenal and/or ampullary adenomas (DAs) are uncommon, they are increasingly diagnosed during upper endoscopy. These patients have a 3- to 7-fold increased risk of colonic neoplasia as compared with the normal population. It is unknown, however, whether they also have an increased risk of additional small-bowel (SB) polyps. Our aim was to establish the prevalence of small-bowel (SB) polyps in patients with DA. Methods In a single-center, prospective study, we used video capsule endoscopy (VCE) to investigate the prevalence of SB polyps in patients with a DA compared with patients undergoing VCE for obscure gastrointestinal bleeding (OGIB) or iron deficiency anemia (IDA). Results Over 25 months, 201 patients were enrolled in the study; the mean age was 65 years and 47% were male. There were 101 control patients and 100 DA cases (mean size 30 mm, (range 10-80 mm)). We did not identify any SB polyps in either group. Colonic polyps were found more frequently in the DA group compared with controls (61% vs 37%, respectively (p=0.002)). Advanced colonic adenoma (HGD, >10 mm, villous histology) were found in 18% of the DA group and 5% of the control group (p=0.018). Conclusion Our data suggest that patients with a DA are not at risk for additional SB polyps and hence does not support screening with VCE. However, colonoscopy is mandatory due to the significantly higher risk of colonic polyps including advanced adenomas.