Background Patients with familial adenomatous polyposis (FAP) are at increased risk of developing gastric adenomas. There is limited understanding of their clinical course and no consensus on management. We reviewed the management of gastric adenomas in patients with FAP from two centres. Patients and methods Patients with FAP and histologically confirmed gastric adenomas were identified between 1997-2018. Patient demographics, adenoma characteristics management/surveillance outcomes were collected. Results One hundred and four (49 female) of 726 patients (14%) were diagnosed with gastric adenomas at a median age of 47 years (range 19-80). The median size of gastric adenoma was 6mm (range 1.5-50mm); 64 (62%) patients had adenomas located distal to the incisura. Five (5%) patients had gastric adenomas demonstrating high grade dysplasia (HGD) on initial diagnosis, distributed equally within the stomach. The risk of HGD was associated with adenoma size (p=0.04). Of adenomas larger than 20mm, 33% contained HGD. Two patients had gastric cancer at initial gastric adenoma diagnosis. Sixty-three (61%) patients underwent endoscopic therapy for gastric adenomas. Complications occurred in three (5%) patients and two (3%) had recurrence, all following piecemeal resection of large (30-50mm) lesions. Three patients were diagnosed with gastric cancer during follow-up, a median of 66 months (range 66-115) after initial diagnosis. Conclusions In this series, we observed gastric adenomas in 14% of patients with FAP. Five per cent contained HGD; risk of HGD correlated with adenoma size. Endoscopic resection was feasible, with few complications and low recurrence rates, but does not completely eliminate the cancer risk.

This result suggests that extended colectomy reduces the risk of mCRC by over four-fold compared with segmental colectomy. mCRC occurred in the segmental group despite postoperative endoscopic surveillance. This needs to be borne in mind when deciding on the appropriate surgical management of LS patients with CRC. We recommend that extended colectomy should be considered for patients with confirmed LS CRC.

ObjectivesTo determine whether modified transperineal template prostate mapping (TTPM) biopsy protocols, altering the template or the biopsy density, have sensitivity and negative predictive value equal to full 5mm TTPM. Materials and MethodsRetrospective analysis of an institutional registry including treatment-naïve men undergoing 5mm TTPM analysed in 20 zones fashion. The value of three modified strategies was assessed by comparing the information provided by selected zones against full 5mm TTPM.Strategy 1 did not consider the findings of anterior areas; strategies 2 and 3 simulated a reduced biopsy density by excluding intervening zones. A bootstrapping technique was employed to calculate reliable estimates of sensitivity and negative predictive value of these three strategies with respect to detection of clinically significant disease (maximum cancer core length >/= 4mm and/or Gleason score >/= 3+4).Results 391 men with median age 62 years (IQR 58-67) were included. Median PSA and PSA density were 6.9 ng/ml (IQR 4.8-10) and 0.17 (IQR 0.12-0.25), respectively. A median of 6 cores (IQR 2-9) out of 48 taken per man (IQR 33-63) were positive for prostate cancer. No cancer was detected in 67 men (17%), whilst low, intermediate and high risk disease was identified in 78 (20%), 80 (21%) and 166 (42%), respectively. Strategy 1, 2 and 3 had sensitivities of 78% (95% CI 73-84%), 85% (95% CI 80-90%) and 84% (95% CI 79-89%), respectively. The negative predictive values of the three strategies was at 73% (95% CI 67-80%), 80% (95% CI 74-86%) and 79% (95% CI 72-84%), respectively. ConclusionAltering the template or decreasing sampling density has a substantial negative impact on the ability of TTPM to rule out clinically significant disease. This should be considered when modified TTPM strategies are performed to select men for tissue-preserving approaches, and when modified TTPM are employed to validate new diagnostic tests.