Risk factors for advanced duodenal and ampullary adenomatosis in familial adenomatous polyposis: a prospective, single-center study

Abstract

Background and study aims To determine the clinical features associated with advanced duodenal and ampullary adenomas in familial adenomatous polyposis. Secondarily, we describe the prevalence and clinical significance of jejunal polyposis. Patients and methods This is a single center, prospective study of 62 patients with familial adenomatous polyposis. Duodenal polyposis was classified according to Spigelman and ampullary adenomas were identified. Patients with Spigelman III and IV duodenal polyposis underwent balloon assisted enteroscopy. Predefined groups according to Spigelman and presence or not of ampullary adenomas were related to the clinical variables: gender, age, family history of familial adenomatous polyposis, type of colorectal surgery, and type of colorectal polyposis. Results Advanced duodenal polyposis was present in 13 patients (21 %; 9 male) at a mean age of 37.61 ± 13.9 years. There was a statistically significant association between family history of the disease and groups according to Spigelman ( P = 0.03). Seven unrelated patients (6 male) presented ampullary adenomas at a mean age of 36.14 ± 14.2 years. The association between ampullary adenomas and extraintestinal manifestations was statistically significant in multivariate analysis ( P = 0.009). Five endoscopic types of non-ampullary adenoma were identified, showing that lesions larger than 10 mm or with a central depression presented foci of high grade dysplasia. Among 28 patients in 12 different families, a similar Spigelman score was identified; 10/12 patients (83.3 %) who underwent enteroscopy presented small tubular adenomas with low grade dysplasia in the proximal jejunum. Conclusions Advanced duodenal polyposis phenotype may be predictable from disease severity in a first-degree relative. Ampullary adenomas were independently associated with the presence of extraintestinal manifestations.

Use of device-assisted enteroscopy in small bowel disease: an expert consensus statement by the Korean Association for the Study of Intestinal Diseases

“…A prospective study of 62 patients with FAP showed that screening and surveillance with DAE could be useful in FAP patients with advanced duodenal polyposis. However, another study of 18 FAP patients with advanced duodenal polyposis reported that routine DAE is not warranted in patients with FAP because the malignant potential of these lesions is unknown [ 71 , 72 ].…”

“…However, another study of 18 FAP patients with advanced duodenal polyposis reported that routine DAE is not warranted in patients with FAP because the malignant potential of these lesions is unknown. 71,72…”

Systematic review and meta-analysis of colon capsule endoscopy accuracy for colorectal cancer screening. An alternative during the Covid-19 pandemic?

“…This study was structured according to the PRISMA 18 recommendations. 18 It was registered in the PROSPERO international database https://www.crd.york.ac.uk/prospero/ 19 with the study number CRD42020202376.…”

Small Bowel Enteroscopy – A Joint Clinical Guideline from the Spanish and Portuguese Small Bowel Study Groups

“…There is little evidence in determining the indication for DAE in familial adenomatous polyposis patients. Screening and surveillance with DAE of SB adenomas could be useful in patients with Spigelman scores III or IV [111], even though the malignant potential of these lesions is unknown [112][113][114].…”