Surveillance and management of upper gastrointestinal disease in Familial Adenomatous Polyposis

Gallagher, M; Phillips, R. K. S.; Bülow, Steffen

doi:10.1007/s10689-005-5668-0

Cited by 65 publications

(44 citation statements)

References 122 publications

(170 reference statements)

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“…Duodenal adenomas occur in up to 90% of patients with FAP, most commonly at the ampulla, peri-ampullary region or distal duodenum, which is thought to be in part due to the exposure of the duodenal mucosa to bile in a predisposed patient [Bulow et al 2004;Gallagher et al 2006;Spigelman et al 1989]. The lifetime risk of duodenal cancer in patients with FAP is estimated to be 3-5% [Bulow et al 2004;Groves et al 2002;Lepisto et al 2009;Vasen et al 1997].…”

Section: Duodenal Adenomas In Familial Adenomatous Polyposismentioning

confidence: 99%

“…In view of this high risk of duodenal cancer in patients with advanced duodenal polyposis, upper gastrointestinal endoscopic surveillance has been proposed, with examinations beginning from age 25-30 [Cairns et al 2010;Gallagher et al 2006]. Forward and side viewing endoscopes should be used to provide adequate visualization of all the duodenal mucosa [Bulow et al 2004;Groves et al 2002].…”

Section: Surveillance Of Duodenal Familial Adenomatous Polyposismentioning

confidence: 99%

“…The advent of EMR has led to a new potential therapeutic option for large flat duodenal polyps in FAP. This has been proposed for patients with stage II and III disease [Groves et al 2002] and in a small series has been shown to downstage disease in a proportion of patients, but with a significant complication rate of 24% [Gallagher et al 2006]. At present it is not clear whether endoscopic intervention significantly alters the course of the disease, or improves survival or quality of life in patients with a significant duodenal polyp burden.…”

Section: Surveillance Of Duodenal Familial Adenomatous Polyposismentioning

confidence: 99%

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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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Section: Duodenal Adenomas In Familial Adenomatous Polyposismentioning

confidence: 99%

Section: Surveillance Of Duodenal Familial Adenomatous Polyposismentioning

confidence: 99%

Section: Surveillance Of Duodenal Familial Adenomatous Polyposismentioning

confidence: 99%

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Endoscopic management of nonampullary duodenal polyps

Basford

Bhandari

2011

Therap Adv Gastroenterol

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“…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. 5 The stomach is also known as a common site of polyps in FAP patients.…”

Section: Introductionmentioning

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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“…Return to normal histology (34%) and downgrading in the Spigelman stage III and IV in either periampullary or extra-ampullary adenomas have been reported (68,69). However, only longer-term follow up will determine whether repeated endoscopic intervention, either alone or in combination with pharmacological therapy, may be offer to selected patients.…”

Section: Extracolonic Tumor Surveillancementioning

confidence: 99%

Recognition and management of hereditary colorectal cancer syndromes

Herraiz

Muñoz-Navas

2009

Rev. esp. enferm. dig.

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Over 1.900 colorectal tumors will arise in association with a hereditary colorectal cancer syndrome in Spain in 2009.The genetic defects responsible for the most common syndromes have been discovered in recent years.Genetic testing helps diagnose affected individuals and allows identification of individuals at-risk.Colonoscopy and prophylactic colectomy decrease colorectal cancer incidence and overall mortality in patients with hereditary colon cancer.Extracolonic tumors are frequent in these syndromes, so specific surveillance strategies should be offered.Key words: Familial adenomatous polyposis. Lynch syndrome. MYH-associated polyposis. Hereditary colon cancer. INTRODUCTIONIn 2009, it is estimated that around 38,000 people (1) in Spain will be diagnosed with colorectal cancer (CRC). Among these cases, more than 15% will exhibit familial clustering, and over 1,900 tumors (5%) will arise in association with a hereditary colorectal cancer syndrome. The most common hereditary colon cancer syndromes are: Familial Adenomatous Polyposis (FAP), attenuated FAP (AFAP), MYH associated polyposis (MAP), and Lynch syndrome, also known as Hereditary Non-Polyposis Colorectal Cancer syndrome (HNPCC) (2).During the last two decades, the most important advancement has been the identification of the genes that underlie these syndromes. This has permitted more accurate classifications of the various syndromes based upon genetic criteria, and consequently this has resulted in more tailored management strategies based on these criteria (3). The management of individuals with hereditary colon cancer or at-risk for hereditary colon cancer is dramatically different, so recognizing these syndromes is critical. Specifically, surveillance strategies for colon and extra-colonic tumors as well as surgical approaches (4) for the prevention and treatment of cancer reflect the heightened risks.This review is focused on current treatment strategies in hereditary colon cancer. It is important to recognize that "treatment" includes not only management of already diagnosed cancers but also to prevention of cancer in these high-risk populations. We first briefly summarize the major clinical features of each syndrome, including pattern of inheritance and penetrance, age at diagnosis and associated extra-colonic tumors. Familial adenomatous polyposis and attenuated FAPFAP is the most common adenomatous polyposis syndrome. Its prevalence is 1:5.000-10.000, with a uniform worldwide distribution, affecting both genders equally (5). Inherited in an autosomal dominant manner with a virtually penetrance of 100%, it is caused by a germline mutation in the Adenomatous Polyposis Coli (APC) tu- POINT OF VIEWmor suppressor gene on chromosome 5q21 (6). In 15-20%, the cases are "de novo" without clinical or genetic evidence of FAP in the parents (7). Recent studies indicate the presence of mosaicism in approximately 15% of such cases (8,9).Classic FAP is characterized by the development of hundreds to thousands of colorectal adenomas starting during the...

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Surveillance and management of upper gastrointestinal disease in Familial Adenomatous Polyposis

Cited by 65 publications

References 122 publications

Endoscopic management of nonampullary duodenal polyps

Endoscopic management of nonampullary duodenal polyps

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

Recognition and management of hereditary colorectal cancer syndromes

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