Cap-assisted forward-viewing endoscopy to visualize the ampulla of Vater and the duodenum in patients with familial adenomatous polyposis

Abstract

Guidelines recommend surveillance endoscopy with both forward- and side-viewing endoscopes to identify duodenal and ampullary adenomas in patients with familial adenomatous polyposis (FAP). We hypothesized that both the duodenum and the ampulla of Vater can be completely visualized during cap-assisted forward-viewing endoscopy. A total of 40 patients with FAP underwent forward-viewing endoscopy with a short cap attached to the tip of the gastroscope, with the aim of visualizing both the duodenum and the ampulla of Vater. If unsuccessful, the procedure was followed by a side-viewing endoscopy. Adverse events were reported. The duodenum, including the ampulla of Vater, was completely visualized using the cap in 38/40 patients (95.0 %). The ampulla could not be visualized using the cap in two patients, both of whom underwent additional side-viewing endoscopy, which was successful. No adverse events occurred. This study showed that cap-assisted endoscopy can be used effectively and safely to visualize both the duodenum and the ampulla of Vater in patients with FAP. This practice might reduce burden, time, and costs of an additional side-viewing endoscopy.

Cap-assisted endoscopy increases ampulla of Vater visualization in high-risk patients

“…The rate of complete AV visualization with CAE was similar to the finding from two other previous studies that both included examinations of healthy patients [ 10 , 11 ] and one study that just involved FAP patients [ 18 ] (91.3, 97, and 95%, respectively). In contrast to these comparisons, our rate of complete AV visualization with FVE was quite different to that of Abdelhafez et al [ 11 ] (51% vs. 80.8%) and of Choi [ 10 ] (51% vs. 24%).…”

“…In our study, both the FVE and CAE procedures were only performed by endoscopy residents, who had no previous experience with ERCP using the side-viewing endoscopes. We obtained the similar rates of complete AV visualization as previous studies where the exams were performed by experienced endoscopists with ERCP (91.3%) [ 10 ] and endoscopist who did not routinely perform ERCPs (95%) [ 18 ] suggesting that CAE is a simple procedure, with faster learning curve than ERCP and can be generalized to conventional endoscopists. For three patients, AV was partially or failed to be visualized even with CAE.…”

Familial Adenomatous Polyposis Syndrome: An Update and Review of Extraintestinal Manifestations

“…125 As a colectomy will not eliminate the risk for malignancy (tumors may arise from remaining segments of the intestinal system including perianally or in the ileal pouch), surveillance should not be neglected in patients who are status post colectomy. While the incidence of ileal cancer is low (with development of ileal adenoma and adenocarcinoma at 10-year follow-up found to be 45% and 1%, respectively), 127 the incidence of rectal cancer in patients where the rectum is not fully removed remains high without adequate follow-up surveillance. Most of these patients will ultimately require rectal resection.…”

“…A family history of early-onset gastric or duodenal cancers should also prompt earlier screening. 127 Repeated screening endos- copies should be performed every 3 to years in individuals without duodenal adenomas. 13 Stomach.…”

“…Most of these patients will ultimately require rectal resection. 13,127 Screening for these patients should involve endoscopy of the rectum or ileum at least every other year. 13 A discontinuation of intensive testing has been suggested only for the first-degree relatives of affected patients who have not had adenomas detected on previous examinations, or for members of families with similarly negative examination findings and without an identified pathogenic APC mutation.…”