Management of Duodenal Adenomas in Familial Adenomatous Polyposis

Characterization of the MUC1.Tg/MIN transgenic mouse as a model for studying antigen-specific immunotherapy of adenomas

“…Since these adenomas do not progress to invasive carcinoma, the MIN model is considered an appropriate model for studying human polyposis. In humans harboring the familial adenomatous polyposis (FAP) mutation that develop multiple adenomas in the gastrointestinal tract, routine endoscopy and prophylactic colectomy are indicated to prevent the development of duodenal and colon cancers [44]. Despite these interventions, these patients have a significant risk of developing invasive duodenal adenocarcinoma.…”

Evaluation and management of periampullary tumors

“…Of six patients with cancer found in one surveillance program, five were unresectable, and the resected patient had a recurrence 3 years after pancreatoduodenectomy [60••]. Lack of any proven therapy short of radical surgery for late-stage polyposis underlies the ineffectiveness of surveillance programs [65]. Chemoprevention has not shown a benefit in reducing cancer risk in duodenal polyposis [66,67].…”

“…An endoscopic approach to macroscopic adenomas is still advocated, even in the absence of randomized trials with other types of treatment, such as surgery [5•]. However, the problem with endoscopic methods is that microscopic disease remains, the genetic predisposition to adenoma formation is unaltered, and frequent endoscopic follow-up is required [56,59,65]. As expected, results following endoscopic therapy in FAP patients are inferior to those achieved in sporadic adenoma patients [32••].…”