The Role of Chromoendoscopy in the Surveillance of the Duodenum of Patients with Familial Adenomatous Polyposis

Abstract

Adenomas of the duodenum have been described in patients with familial adenomatous polyposis (FAP). Patients with FAP are at high risk for the development of periampullary cancer. The aim of our study was to evaluate if endoscopic visualization of small polyps, often overlooked at standard endoscopic examination, was improved by chromoendoscopy. Ten patients with FAP and previous colectomy underwent upper gastrointestinal endoscopy. Two skilled endoscopists were involved for each endoscopy. Evaluation of number and diameter of polyps was made before and after staining. After staining we detected a larger number of duodenal polyps than found at the standard endoscopic examination, the difference being statistically significant. This result seems to suggest that chromoendoscopy may improve diagnostic yield of endoscopy. Further studies are needed to suggest the best surveillance program and the appropriate therapeutic modality for these patients.

Familial adenomatous polyposis: a review of gastrointestinal manifestations

“…Microadenomas (pathognomonic of FAP) are present in normal appearing papillae as early as 20.5 years, compared to visible adenomas which are seen at a mean age of 52 years. 38 Newer endoscopic techniques such as chromoendoscopy 41 and narrow band imaging 42,43 have improved the detection rate of small polyps.…”

Endoscopic management of nonampullary duodenal polyps

“…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.…”

Familial Adenomatous Polyposis

“…Chromoendoscopy may improve diagnostic yield of endoscopy [9]. Jejunal adenomas in FAP patients are reported occasionally and can progress into adenocarcinoma with a poor prognosis.…”