CASE REPORT: POST-MEGASTENT DUODENAL POLYP

Volume 12 , Issue 3 , September 2022 , Pages 317-320

Authors

Mohammed Omer Mohammed 1 ; Araz Latif Raheem 2 ; Ali Jabbar Ahmed 3

1 College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.

2 Gastroenterology and Hepatology Teaching Hospital, Sulaimani, Kurdistan Region, Iraq.

3 KBMS board trainee, Gastroenterology and Hepatology Teaching Hospital, Sulaimani, Kurdistan Region, Iraq.

DOI logo 10.17656/jsmc.10374

Keywords

Abstract

INTRODUCTION
Most duodenal polyps are non-neoplastic. Instead, they represent regenerative/hyperplastic nodules of foveolar
epithelium or Brunner gland proliferation (38%). Other less common polyps include heterotopic (6%) and
neoplastic lesions (11%) (1). Adenomas of intestinal type are the most common (89%), followed by adenomatous
lesions that present a gastric phenotype: PGAs (8%) and foveolar-type adenomas (3%) (2).
Non-neoplastic duodenal polyps, most of which represent regenerative inflammatory (pseudo) polyps,
are predominantly localized in the bulb (80%) (1). The majority are associated with duodenitis, especially
in the setting of peptic injury, and are less commonly associated with inflammatory bowel disease
or rare conditions such as primary immunodeficiencies. (3). Histologically, non-neoplastic duodenal
polyps may resemble gastric hyperplastic polyps and frequently show metaplastic foveolar epithelium
with active inflammation and/or erosion, reactive epithelial changes, seamless transition with the
surrounding epithelium, and surface maturation. They may also simply be composed of granulation
tissue. It is worth underscoring that some of these polyps are neoplastic. Some hyperplastic polyps
harbor KRAS and BRAF mutations and tend to show serrated features, similar to their microvascular
colonic counterparts (4). Duodenal hyperplastic polyps with KRAS mutation may represent precursor
lesions of duodenal traditional serrated adenomas (4). The polypoid heterotopic gastric mucosa is
another frequent type of duodenal polyps. As opposed to the peptic injury-induced foveolar metaplasia,
lesions of this type also contain clusters of oxyntic glands under the surface of the foveolar epithelium.
Duodenal gastric heterotopia is associated with FGPs and PPI therapy.

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