Endoscopy 2008; 40(9): 773-774
DOI: 10.1055/s-2008-1077487
Case report

© Georg Thieme Verlag KG Stuttgart · New York

Double balloon endoscopy for detection of small-bowel adenomas in familial adenomatous polyposis after pancreaticoduodenectomy according to Whipple

A.  M.  J.  Langers1 , W.  H.  De Vos tot Nederveen Cappel1 , R.  A.  Veenendaal1 , B.  A.  Bonsing2 , J.  C.  H.  Hardwick1 , H.  F.  A.  Vasen1
  • 1Department of Gastroenterology, Leiden University Medical Center, Leiden, The Netherlands
  • 2Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
Further Information

Publication History

submitted 4 March 2008

accepted after revision 9 June 2008

Publication Date:
20 August 2008 (online)

Patients with familial adenomatous polyposis (FAP) have a 5 % – 10 % lifetime risk of developing duodenal cancer. In severe duodenal polyposis, pancreaticoduodenectomy according to Whipple has been considered the only way to cure duodenal polyposis. However, polyps recur even after surgery. We describe a patient with severe adenomatosis of the small bowel in the afferent loop of a Roux-en-Y anastomosis after a Whipple procedure, detected by double balloon endoscopy (DBE). This is the first description of the use of DBE for this indication, and emphasizes the need for surveillance of the small bowel after surgery, especially in the area of the biliary anastomosis.

References

  • 1 Church J M, McGannon E, Hull-Boiner S. et al . Gastroduodenal polyps in patients with familial adenomatous polyposis.  Dis Colon Rectum. 1992;  35 1170-1173
  • 2 Spigelman A D, Williams C B, Talbot I C. et al . Upper gastrointestinal cancer in patients with familial adenomatous polyposis.  Lancet. 1989;  2 783-785
  • 3 Bjork J, Akerbrant H, Iselius L. et al . Periampullary adenomas and adenocarcinomas in familial adenomatous polyposis: cumulative risks and APC gene mutations.  Gastroenterology. 2001;  121 1127-1135
  • 4 Vasen H F, Bulow S, Myrhoj T. et al . Decision analysis in the management of duodenal adenomatosis in familial adenomatous polyposis.  Gut. 1997;  40 716-719
  • 5 Bülow S, Björk J, Christensen I J. et al . Duodenal adenomatosis in familial adenomatous polyposis.  Gut. 2004;  53 381-386
  • 6 Penna C, Phillips R K, Tiret E. et al . Surgical polypectomy of duodenal adenomas in familial adenomatous polyposis: experience of two European centres.  Br J Surg. 1993;  80 1027-1029
  • 7 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
  • 8 De Vos tot Nederveen Cappel W H, Järvinen H J, Björk J. et al . Worldwide survey among polyposis registries of surgical management of severe duodenal adenomatosis in familial adenomatous polyposis.  Br J Surg. 2003;  90 705-710

A. M. J. Langers, MD

Department of Gastroenterology
Leiden University Medical Center

Postbus 9600
2300 RC Leiden
The Netherlands

Fax: + 31-71-5248115

Email: a.m.j.langers@lumc.nl