Endoscopic management of duodenal adenomatosis in familial adenomatous polyposis—A case‐based review

Abstract

Adenomatous polyposis (AP) diseases, including familial adenomatous polyposis (FAP), attenuated FAP (AFAP), and MUTYH-associated polyposis (MAP), are the second most common hereditary causes of colorectal cancer. A frequent extracolonic manifestation of AP disease is duodenal polyposis, which may lead to duodenal cancer in up to 18% of AP patients. Endoscopic surveillance is recommended at 0.5-to 5-year intervals depending on the extent of polyp growth and histological progression. Although the Spigelman classification is traditionally used to determine surveillance intervals, it lacks information on the (peri-) ampullary site, where 50% of duodenal carcinomas are located. Hence, information on the papilla has recently been added as a prognostic marker. Patients with duodenal adenoma(s) ≥10 mm and ampullary adenomas of any size are suggested to be referred to an expert center for endoscopic therapy, particularly endoscopic mucosal resection and endoscopic ampullectomy. Nonetheless, despite the logic of this approach, the long-term efficacy of endoscopic therapy is still to be demonstrated.

Advantages of total proctocolectomy with straight ileoanal anastomosis plus pedicled omental transposition for familial adenomatous polyposis: a preliminary study

“…For recurrent adenomas, the necessity of rectal resection has not been determined. Some studies have confirmed the success rate of endoscopic resection, but the long-term efficacy of endoscopic therapy remains to be proven due to the high risk of recurrence [ 19 , 20 ]. Proctectomy is radical and advisable for patients without special requirements.…”

Endoscopic Surveillance and Treatment of Upper GI Tract Lesions in Patients with Familial Adenomatous Polyposis—A New Perspective on an Old Disease

“…Endoscopic surveillance of the GI tract appears to be essential in patients with FAP. Screening colonoscopies in families of FAP patients and prophylactic colectomy in diagnosed patients have importantly reduced the incidence of colorectal cancer [ 21 ]. However, the significantly decreased mortality due to lower GI malignancy substantially raised the importance of upper GI tract endoscopy due to the high risk of duodenal adenomatosis and, as a consequence, duodenal cancer incidence.…”

Endoscopic indicators in patients with familial adenomatous polyposis undergoing duodenal resections – a nationwide Danish cohort study with long-term follow-up

“…This system integrates factors such as the number and size of the adenomas, along with their morphology and the extent of dysplasia 7 . Although the Spigelman classi cation has been validated, it tends to underestimate the importance of ampullary lesions and does not closely correlate with the risk of duodenal cancer [8][9][10][11] . Additionally, it requires obtaining biopsies from duodenal lesions that many endoscopists would prefer to remove completely, either by simple polypectomy or endoscopic mucosal resection (EMR) [12][13][14] .…”