Duodenal adenoma surveillance in patients with familial adenomatous polyposis

Abstract

Familial adenomatous polyposis (FAP) is a hereditary disorder caused by Adenomatous Polyposis Gene mutations that lead to the development of colorectal polyps with great malignant risk throughout life. Moreover, numerous extracolonic manifestations incorporate different clinical features to produce varied individual phenotypes. Among them, the occurrence of duodenal adenomatous polyps is considered an almost inevitable event, and their incidence rates increase as a patient's age advances. Although the majority of patients exhibit different grades of duodenal adenomatosis as they age, only a small proportion (1%-5%) of patients will ultimately develop duodenal carcinoma. Within this context, the aim of the present study was to review the data regarding the epidemiology, classification, genetic features, endoscopic features, carcinogenesis, surveillance and management of duodenal polyps in patients with FAP.

Surgical outcomes for duodenal adenoma and adenocarcinoma: a multicentre study in Australia and the United Kingdom

“…It seems reasonable that high-grade dysplastic lesions need to be dealt with aggressively due to the potential of developing malignancy, as is seen in other pathologies such as oesophageal lesions in Barrett's. 22 Surgical resection is curative but carries significant morbidity and mortality with an expected rate of POPF higher than for pancreatic resection for other pathologies as demonstrated here. Endoscopic mucosal resection is an option for high-grade dysplastic lesions and is less invasive compared to surgical resection.…”

“…Currently, there is no consensus regarding management of sporadic duodenal adenoma, largely due to rarity of the diagnosis and an unclear natural history. It seems reasonable that high‐grade dysplastic lesions need to be dealt with aggressively due to the potential of developing malignancy, as is seen in other pathologies such as oesophageal lesions in Barrett's . Surgical resection is curative but carries significant morbidity and mortality with an expected rate of POPF higher than for pancreatic resection for other pathologies as demonstrated here.…”

Advanced duodenal neoplasia and carcinoma in familial adenomatous polyposis: outcomes of surgical management

“…Furthermore, high-resolution endoscopy and narrowband imaging did not improve malignant estimates over Spigelman score (39). Moreover, a large number of lesions and their sessile appearance may add technical problems and difficult endoscopic management by argon plasma coagulation or resection (23). Finally, recurrence rate of duodenal lesions after endoscopic intervention remains high (30).…”

“…For example, when compared to Western countries, the incidence of gastric and duodenal cancers has been reported to be higher and lower in Asia, respectively (18,34). Furthermore, length of follow-up, endoscopic techniques (use of side-viewing endoscopy, high resolution endoscopy, chromoendoscopy), strategies for prevention, frequent endoscopic resection of at risk lesions, ampullary localization have also been incriminated to influence incidence rates (23). Usually, duodenal polyps are more often recognized 10-20 years after the diagnosis of colonic polyposis (35,36).…”

“…So far, the development of duodenal carcinoma during the evolution of FAP patients has deserved scarce attention in Brazilian publications (21)(22)(23). Thus, we decided to investigate the prevalence, clinical features and surgical outcomes of FAP duodenal advanced adenomas and carcinoma that have been diagnosed and treated in the greatest public hospital in Brazil.…”