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Introduction <p>Familial adenomatous polyposis (FAP) confers high periampullary malignancy risk. Early detection remains challenging. This prospective cohort study evaluated whether protocolized routine biopsy improves adenoma detection regardless of endoscopic appearance.</p> Methods <p>Fifty-one FAP patients underwent esophagogastroduodenoscopy with protocolized routine duodenal papilla biopsies, independent of macroscopic findings. Comprehensive data collection included demographics, endoscopic characteristics, Spigelman staging, and complications. Histological diagnoses were confirmed, and statistical analyses identified adenoma-associated factors.</p> Results <p>Ampullary adenomas were detected in 62.75% (32/51). Crucially, 53.13% (17/32) occurred in endoscopically normal papillae, while 84.38% (27/32) of adenoma patients had prior negative endoscopic screenings. Beyond Spigelman stage, significant correlations with papilla adenomas included combined gastric antral adenomas (<i>R</i> = 0.470, <i>p</i> = 0.037), use of transparent cap (<i>R</i> = 0.691, <i>p</i> = 0.003), and abnormal papillary appearance (<i>R</i> = 0.885, <i>p</i> &lt; 0.001). Subgroup analysis of normal-appearing papillae further confirmed significant associations for occult adenoma detection with use of transparent cap (<i>R</i> = 0.846, <i>p</i> &lt; 0.001), increased papilla size (<i>R</i> = 0.481, <i>p</i> = 0.003), higher Spigelman stage (<i>R</i> = 0.672, <i>p</i> = 0.004), and combined antral adenomas (<i>R</i> = 0.753, <i>p</i> = 0.011).</p> Conclusion <p>Routine papilla biopsy significantly improves adenoma detection in FAP patients, especially with transparent caps. Gastric antral adenomas serve as potential predictors of ampullary neoplasia, supporting their integration into risk-adapted surveillance strategies.</p> Clinical trial registration <p>This trial has been prospectively registered in Chinese Clinical Trial Registry: ChiCTR2300077846.</p> <p></p>

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Routine duodenal papillary biopsy enhances detection of duodenal papillary adenoma in familial adenomatous polyposis patients: a prospective cohort study

  • 期刊论文

  • 发表日期：

    2026年7月22日

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  • Wei-Na Jing,
  • Bin-Yang Luo,
  • Fei-Fan Chen,
  • Ruo-Ting Men,
  • Xue Xiao,
  • Kai Deng,
  • Jin-Lin Yang,
  • Zhu Wang

摘要

Introduction

Familial adenomatous polyposis (FAP) confers high periampullary malignancy risk. Early detection remains challenging. This prospective cohort study evaluated whether protocolized routine biopsy improves adenoma detection regardless of endoscopic appearance.

Methods

Fifty-one FAP patients underwent esophagogastroduodenoscopy with protocolized routine duodenal papilla biopsies, independent of macroscopic findings. Comprehensive data collection included demographics, endoscopic characteristics, Spigelman staging, and complications. Histological diagnoses were confirmed, and statistical analyses identified adenoma-associated factors.

Results

Ampullary adenomas were detected in 62.75% (32/51). Crucially, 53.13% (17/32) occurred in endoscopically normal papillae, while 84.38% (27/32) of adenoma patients had prior negative endoscopic screenings. Beyond Spigelman stage, significant correlations with papilla adenomas included combined gastric antral adenomas (R = 0.470, p = 0.037), use of transparent cap (R = 0.691, p = 0.003), and abnormal papillary appearance (R = 0.885, p < 0.001). Subgroup analysis of normal-appearing papillae further confirmed significant associations for occult adenoma detection with use of transparent cap (R = 0.846, p < 0.001), increased papilla size (R = 0.481, p = 0.003), higher Spigelman stage (R = 0.672, p = 0.004), and combined antral adenomas (R = 0.753, p = 0.011).

Conclusion

Routine papilla biopsy significantly improves adenoma detection in FAP patients, especially with transparent caps. Gastric antral adenomas serve as potential predictors of ampullary neoplasia, supporting their integration into risk-adapted surveillance strategies.

Clinical trial registration

This trial has been prospectively registered in Chinese Clinical Trial Registry: ChiCTR2300077846.