Health

Who should undergo endoscopic screening and surveillance for pancreatic cancer?  Endoscopic screening and surveillance for pancreatic cancer are not recommended for the general population because of the overall low prevalence of the disease, the inaccuracy of available testing modalities, and the high expense. Some experts advocate that first-degree relatives of patients with familial pancreatic cancer …

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What is the role of capsule endoscopy in small bowel surveillance for PJS?  Patients with PJS have a significantly increased risk of developing dysplastic polyps and malignancies along the entire length of the small bowel. Capsule endoscopy is the method of choice for small bowel surveillance in PJS and should be performed every 2 years …

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When should surveillance endoscopy begin for patients with PJS?  PJS places patients at 5% to 10% increased risk of gastric malignancy. The lifetime risk of developing small bowel cancer in PJS is 13%. Endoscopic surveillance of the stomach and duodenum with upper endoscopy should be performed every 2 years beginning at age 10. All visible …

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How often is surveillance endoscopy performed on patients who have undergone endoscopic resection of ampullary adenomas?  Patients who have undergone endoscopic management of ampullary adenomas should have regular endoscopic surveillance for the detection of recurrent dysplasia with both a forward- and a side-viewing endoscope. Follow-up endoscopy and multiple biopsies should be performed every 6 months …

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What is the upper GI tract endoscopic surveillance strategy for patients with FAP?  Individuals with FAP should undergo endoscopic surveillance for duodenal adenomas with examinations beginning around the time the patient is being considered for colectomy or early in the third decade of life. The upper endoscopy needs to be performed with both end-viewing and …

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What are the endoscopic surveillance guidelines for sporadic duodenal adenomas?  Sporadic duodenal adenomas are usually removed completely with endoscopic techniques, and surveillance endoscopy is usually performed to ensure complete tissue removal and to assess for recurrence. Currently, there is no established surveillance interval for patients with sporadic duodenal adenomas. Patients discovered to have advanced (stage …

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Who is at risk for ampullary and nonampullary duodenal adenomas?  Ampullary and nonampullary duodenal adenomas can occur sporadically or in association with genetic syndromes such as familial adenomatous polyposis (FAP) or Peutz-Jeghers syndrome (PJS). Ampullary adenomas are considered premalignant lesions that can be treated surgically or endoscopically. Nonampullary duodenal adenomas have the potential for malignant …

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