Endoscopy 1999; 31(6): 412-416
DOI: 10.1055/s-1999-41
Original Article
Georg Thieme Verlag Stuttgart ·New York

Management of Duodenal Adenomas in 98 Patients with Familial Adenomatous Polyposis

 I. Heiskanen,  I. Kellokumpu,  H. Järvinen
  • Second Dept. of Surgery, Helsinki University Central Hospital, Helsinki, Finland
Further Information

Publication History

Publication Date:
31 December 1999 (online)

Background and Study Aims: The advantage of endoscopic surveillance and treatment of duodenal polyposis is still unclear in familial adenomatous polyposis (FAP). The aim of this study was to evaluate the progression patterns of duodenal polyposis and the results of treatment.

Patients and Methods: In our institution, the 98 FAP patients included in the prospective follow-up study underwent at least one upper endoscopic examination, carried out with few exceptions, by a single surgeon endoscopist. The progression patterns of duodenal polyposis, the cumulative risk of severe duodenal polyposis and duodenal cancer as well as the results of surgical treatment were evaluated during a median follow-up of 11 years.

Results: Duodenal adenomas were detected in 78 patients corresponding to a cumulative lifetime incidence of 97 %. The stage of adenomatosis progressed in 52 (73 %) of the 71 patients who underwent repeated endoscopies. The cumulative risks of stage IV adenomatosis and duodenal carcinoma were 30 % and 4 %, respectively. Excisional treatment through open duodenotomy resulted in significant stage regression but was followed by new progression. In all patients the median interval for progression by one stage varied from 4 to 11 years.

Conclusions: Duodenal adenomas almost invariably occur in FAP; endoscopic surveillance is thus warranted to anticipate severe progression and malignant transformation. Excisional surgical treatment can, however, give only transient stage reduction.

References

  • 1 Sarre R G, Frost A G, Jagelman D G, et al. Gastric and duodenal polyps in familial adenomatous polyposis: a prospective study of the nature and prevalence of upper gastrointestinal polyps.  Gut. 1987;  28 306-314
  • 2 Spigelman A D, Williams C B, Talbot I C, et al. Upper gastrointestinal cancer in patients with familial adenomatous polyposis.  Lancet. 1989;  II 783-785
  • 3 Debinski H S, Spigelman A D, Hatfield A, et al. Upper intestinal surveillance in familial adenomatous polyposis.  Eur J Cancer. 1995;  31A 1149-1153
  • 4 Marcello P W, Asbun H J, Veidenheimer M C, et al. Gastroduodenal polyps in familial adenomatous polyposis.  Surg Endosc. 1996;  10 418-421
  • 5 Richard C S, Berk T, Bapat B V, et al. Sulindac for periampullary polyps in FAP patients.  Int J Colorect Dis. 1997;  12 14-18
  • 6 Norfleet R G. Screening for upper gastrointestinal neoplasms in patients with familial adenomatous polyposis and Gardner's syndrome (editorital).  J Clin Gastroenterol. 1992;  14 (2) 95-96
  • 7 Vasen H FA, Bülow S, Myrhøj T, et al. Decision analysis in the management of duodenal adenomatosis in familial adenomatous polyposis.  Gut. 1997;  40 716-719
  • 8 Jagelman D G, DeCosse J J, Bussey H JR, Leeds Castle Polyposis Group. Upper gastrointestinal cancer in familial adenomatous polyposis.  Lancet. 1988;  I 1149-1151
  • 9 Offerhaus G JA, Giardiello F M, Krush A J, et al. The risk of upper gastrointestinal cancer in familial adenomatous polyposis.  Gastroenterology. 1992;  102 1980-1982
  • 10 Penna C, Bataille N, Balladur P, et al. Surgical treatment of severe duodenal polyposis in familial adenomatous polyposis.  Br J Surg. 1998;  85 665-668
  • 11 Penna C, Phillips R KS, Tiret E, Spigelman A D. Surgical polypectomy of duodenal adenomas in familial adenomatous polyposis: experience of two European centres.  Br J Surg. 1993;  80 1027-1029
  • 12 Spigelman A D, Talbot I C, Penna C, et al. Evidence for adenoma-carcinoma sequence in the duodenum of patients with familial adenomatous polyposis.  J Clin Pathol. 1994;  47 709-710
  • 13 Bülow S, Alm T, Fausa O, et al. Duodenal adenomatosis in familial adenomatous polyposis.  Int J Colorect Dis. 1995;  10 43-46
  • 14 Church J M, McGannon E, Hull-Boiner S, et al. Gastroduodenal polyps in patients with familial adenomatous polyposis.  Dis Colon Rectum. 1992;  36 1170-1173
  • 15 Iida M, Yao T, Itoh H, et al. Natural history of duodenal lesions in Japanese patients with familial adenomatosis coli (Gardner's syndrome).  Gastroenterology. 1989;  96 1301-1306
  • 16 Noda Y, Watanabe H, Ida M, et al. Histologic follow-up of ampullary adenomas in patients with familial adenomatosis coli.  Cancer. 1992;  70 1847-1856
  • 17 Wu T T, Kornacki S, Rashid A, et al. Dysplasia and dysregulation of proliferation in foveolar and surface epithelia of fundic gland polyps from patients with familial adenomatous polyposis.  Am J Surg Pathol. 1998;  22 (3) 293-298
  • 18 Zwick A, Munir M, Ryan C K, et al. Gastric adenocarcinoma and dysplasia in fundic gland polyps of a patient with attenuated adenomatous polyposis coli.  Gastroenterology. 1997;  113 659-663
  • 19 Sawada T, Muto T. Familial adenomatous polyposis: should patients undergo surveillance of the upper gastrointestinal tract.  Endoscopy. 1995;  27 6-11
  • 20 Debinski H S, Trojan J, Nugent K P, et al. Effect of sulindac on small polyps in familial adenomatous polyposis.  Lancet. 1995;  345 855-856
  • 21 Wallace M, Phillips R. Upper gastrointestinal disease in patients with familial adenomatous polyposis.  Br J Surg. 1998;  85 742-775
  • 22 Järvinen H. Sulindac and duodenal adenomas in familial adenomatous polyposis.  Int J Colorectal Dis. 1994;  9 55

H. JärvinenM.D. 

Second Department of Surgery

Helsinki University Central Hospital

Haartmaninkatu 4

00290 Helsinki

Finland

Phone: + 358-9-4714675