Observational studyBritish journal of cancer2026
Routine duodenal papillary biopsy enhances detection of duodenal papillary adenoma in familial adenomatous polyposis patients: a prospective cohort study.
Observational study in British journal of cancer, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionFamilial 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.
methodsFifty-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.
resultsAmpullary 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).
conclusionRoutine 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 registrationThis trial has been prospectively registered in Chinese Clinical Trial Registry: ChiCTR2300077846. Papillary biopsy was safe and detected previously missed papillary lesions. Routine biopsy detected adenomas in 62.75% of FAP patients. Combined gastric antral adenoma, the use of transparent cap, abnormal appearance of duodenal papilla, and Spigelman stage were associated with detection of papilla adenomas.
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