High resolution endoscopy and the additional value of chromoendoscopy in the evaluation of duodenal adenomatosis in patients with familial adenomatous polyposis

Dekker, Evelien; Boparai, Karam S.; Poley, JW; Mathus-Vliegen, E. M. H.; Offerhaus, G.J.A.; Kuipers, E.J.; Fockens, Paul; Dees, Jan

doi:10.1055/s-0029-1214980

Cited by 50 publications

(53 citation statements)

References 11 publications

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“…Our study demonstrates that coexistence of gastric polyp is associated with the occurrence of duodenal neoplasm for the first time. The use of side-viewing endoscopy, high resolution endoscopy and chromoendoscopy raises the detection rate of duodenal lesions, 31 so it should be considered to use them in FAP patients who have high risk of duodenal neoplasm.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Gastric and Duodenal Polyps and Risk Factors for Duodenal Neoplasm in Korean Patients with Familial Adenomatous Polyposis

Park¹,

Ryu²,

Park³

et al. 2011

Gut Liver

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Background/Aims: The prevalence of gastric polyps, duodenal adenoma and duodenal cancer has been reported as being high among familial adenomatous polyposis (FAP) patients, but there have been no reports of this association in Korea. This study evaluated the prevalence of gastric and duodenal polyps and risk factors for duodenal neoplasm in FAP patients in Korea. Methods: We reviewed both initial and follow-up endoscopic results from FAP patients. We also investigated the treatment modality of duodenal adenomas and analyzed the risk factors of duodenal neoplasms by logistic regression analysis. Results: A total of 148 patients with FAP underwent esophagogastroduodenoscopy (EGD), and the fi ndings were as follows: gastric polyp 39.9% (fundic gland polyp 25.7% and gastric adenoma 14.2%), duodenal adenoma 15.5%, gastric cancer 2.7%, and duodenal cancer 0.7%. There were two cases of gastric cancer that developed from benign gastric polyps. There were progressions of duodenal adenomatosis during follow-up, and some degree of relapse occurred after endoscopic resection. Patients with gastric polyps showed a correlation with the occurrence of duodenal neoplasm (odds ratio, 2.814; p=0.024). Conclusions: In Korean FAP patients, gastric cancer was detected more frequently, but fundic gland polyps, duodenal adenoma and duodenal cancer were detected less frequently than in Western patients. FAP patients with gastric polyps should undergo regular EGD, particularly for the early detection of duodenal neoplasia. (Gut Liver 2011;5:46-51) Key Words: Familial adenomatous polyposis; Duodenal cancer; Polyps; Adenomas; Gastric cancer INTRODUCTIONFamilial adenomatous polyposis (FAP) is characterized by the presence of at least one-hundred colorectal polyps and an earlyprogression to the colon cancer. Duodenum is the second most commonly affected site of polyp development in FAP patients. 1Duodenal polyps developed in FAP patients are adenomatous polyps, known as pre-cancerous lesions for duodenal adenocarcinoma.2 While prophylactic proctocolectomy has decreased the proportion of colorectal cancer as a cause of death in FAP patients, duodenal cancer has become a more important cause of death for these patients. 3,4 Therefore, endoscopic surveillance is important for the early detection of duodenal cancer and can improve the prognosis of FAP patients. 5The stomach is also known as a common site of polyps in FAP patients. Fundic gland polyps are the most prevalent gastric lesions, followed by adenomatous polyps. 6 In general, gastric cancer arises from adenomatous polyps via the adenomacarcinoma sequence, but several recent reports have shown that gastric adenocarcinoma can be developed from fundic gland polyp in FAP patients. [7][8][9] In this study, we investigated the prevalence of gastric polyps and adenocarcinoma, the changing pattern through follow-up endoscopy and the precancerous possibility of gastric polyp in FAP patients. Also, we described the prevalence of duodenal polyps and adenocarcinoma, progression through follow-up...

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Section: Discussionmentioning

confidence: 99%

Prevalence of Gastric and Duodenal Polyps and Risk Factors for Duodenal Neoplasm in Korean Patients with Familial Adenomatous Polyposis

Park¹,

Ryu²,

Park³

et al. 2011

Gut Liver

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“…indigocarmine chromoendoscopy leads to greater numbers of duodenal adenomas being detected in patients with FAP and an upgrading of the Spigelman stage in 12% of patients [Dekker et al 2009;Picasso et al 2007]. Patients with no visible polyps detected have been shown to have adenomatous tissue on random biopsies in up to 7.6% of cases.…”

Section: Surveillance Of Duodenal Familial Adenomatous Polyposismentioning

confidence: 99%

Endoscopic management of nonampullary duodenal polyps

Basford

Bhandari

2011

Therap Adv Gastroenterol

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Duodenal polyps are a rare finding in patients presenting for gastroscopy, being found in 0.3-4.6% of cases. The majority of patients are asymptomatic. The most common lesions necessitating removal are duodenal adenomas which should be differentiated from other mucosal lesions such as ectopic gastric mucosa, and submucosal lesions such as carcinoids and gastrointestinal stromal tumours (GISTs). Adenomas can occur sporadically or as part of a polyposis syndrome. Both groups carry malignant potential but this is higher in patients with a polyposis syndrome. The majority of sporadic duodenal adenomas are flat or sessile and occur in the second part of the duodenum. Historically duodenal adenomas have been managed by radical surgery, which carried significant mortality and morbidity, or more conservative local surgical excision which resulted in high local recurrence rates. There is growing evidence for the use of endoscopic mucosal resection (EMR) techniques for treatment of sporadic nonampullary duodenal adenomas, with good outcomes and low complication rates. Endoscopic submucosal dissection (ESD) carries greater risk of complications and should be reserved for experts in this technique. Patients with sporadic duodenal adenomas carry an increased risk of colonic neoplasia and should be offered colonoscopy. The impact of endoscopic resection on the course of polyposis syndromes such as familial adenomatous polyposis (FAP) needs further study.

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“…However, environmental and hereditary factors may also affect cancer incidence in FAP cohorts. For example, when compared to Western countries, the incidence of gastric and duodenal cancers has been reported to be higher and lower in Asia, respectively (18,34). Furthermore, length of follow-up, endoscopic techniques (use of side-viewing endoscopy, high resolution endoscopy, chromoendoscopy), strategies for prevention, frequent endoscopic resection of at risk lesions, ampullary localization have also been incriminated to influence incidence rates (23).…”

Section: Discussionmentioning

confidence: 99%

Advanced duodenal neoplasia and carcinoma in familial adenomatous polyposis: outcomes of surgical management

Campos

Bustamante-Lopez

Kanno

et al. 2017

J. Gastrointest. Oncol.

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Background: In addition to the presence of neoplasia in the colon and rectum, patients with familial adenomatous polyposis (FAP) may develop numerous polyps and carcinoma within the upper gastrointestinal tract. Methods:The aim of the present paper was to review the incidence advanced duodenal polyposis or cancer and their surgical outcomes. A retrospective review of patients' records from our department was performed. respectively. Duodenal carcinomas occurred later (55.8 years) when compared to advanced adenomatosis (45.3 years). Three patients were diagnosed due to symptoms, while the others were detected under endoscopic surveillance. Age interval between FAP treatment and duodenal neoplasia diagnosis was 15.3 years . All but one patient underwent duodenopancreatectomy (DP). Two from the 7 patients undergoing DP died, one from pulmonary embolism 30 days after surgery and the other from recurrent T4N0 duodenal tumor. Thus, major operative morbidity and mortality were 12.5%. Conclusions:In this single-center Brazilian series of FAP patients: (I) advanced duodenal neoplasia or cancer requiring surgery occurred in 5.5% of patients; (II) when reaching the fifth decade of life, patients should be carefully evaluated to diagnose and treat early lesions; (III) in spite of the technical complexity of DP, operative morbidity is acceptable in experienced hands; and (IV) continuous surveillance is necessary during follow-up.

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High resolution endoscopy and the additional value of chromoendoscopy in the evaluation of duodenal adenomatosis in patients with familial adenomatous polyposis

Cited by 50 publications

References 11 publications

Prevalence of Gastric and Duodenal Polyps and Risk Factors for Duodenal Neoplasm in Korean Patients with Familial Adenomatous Polyposis

Prevalence of Gastric and Duodenal Polyps and Risk Factors for Duodenal Neoplasm in Korean Patients with Familial Adenomatous Polyposis

Endoscopic management of nonampullary duodenal polyps

Advanced duodenal neoplasia and carcinoma in familial adenomatous polyposis: outcomes of surgical management

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