Gastroduodenal polyps in patients with familial adenomatous polyposis

Abstract

A review of the endoscopy reports and pathology results from esophagogastroduodenoscopy (EGD) of all patients with familial adenomatous polyposis (FAP) undergoing such an examination was performed. Two hundred forty-seven patients were identified, with an overall prevalence of duodenal adenomas of 66 percent and of fundic gland polyps of 61 percent. Analysis of our more recent experience (1986 to 1990) shows the prevalence to be 88 percent and 84 percent, respectively. A normal-appearing papilla was adenomatous in 50 percent of cases. No case of periampullary carcinoma developed in patients under surveillance. Routine EGD is indicated for patients with FAP. Duodenal adenomas and fundic gland polyps will occur in the majority of patients.

Evidence for adenoma-carcinoma sequence in the duodenum of patients with familial adenomatous polyposis. The Leeds Castle Polyposis Group (Upper Gastrointestinal Committee).

“…2 Although the risk for duodenal cancer is significantly greater in patients with FAP than in the normal population,'-5 only about 5% of patients with FAP go on to develop duodenal cancer. Moreover, while it might be expected that the duodenum of patients with FAP conforms to the adenomacarcinoma sequence, 6 there is no evidence for this.…”

Gastric dysplasia may be an independent risk factor of anadvanced colorectal neoplasm

“…The progression of colorectal adenoma to colon cancer is known to be associated with an adenoma size larger than 10 mm, more than three lesions, a villous, tubulovillous or high grade dysplastic histology, and the presence of genetic abnormalities [21][22][23][24] . Genetic abnormalities in colon cancer are very similar to those in gastric cancer [25,26] , especially concerning mutations of the p53 [27,28] , APC [29,30] , DCC [31,32] , and K-ras genes [33,34] . Genetic abnormalities are well known to be associated with upper gastrointestinal polyps and with hereditary colonic polyposis syndromes [25,26] , which include familial polyposis coli [25,26] , Gardner's syndrome, Peutz-Jeghers' syndrome, Cowden's syndrome, Cronkhite-Canada syndrome, hereditary flat adenoma syndrome, and others.…”

“…Genetic abnormalities in colon cancer are very similar to those in gastric cancer [25,26] , especially concerning mutations of the p53 [27,28] , APC [29,30] , DCC [31,32] , and K-ras genes [33,34] . Genetic abnormalities are well known to be associated with upper gastrointestinal polyps and with hereditary colonic polyposis syndromes [25,26] , which include familial polyposis coli [25,26] , Gardner's syndrome, Peutz-Jeghers' syndrome, Cowden's syndrome, Cronkhite-Canada syndrome, hereditary flat adenoma syndrome, and others. In the present study, we deliberately excluded patients with HNPCC, suspected HNPCC, or FAP to avoid the influence of such genetic factors.…”

Polipose gastroduodenal em doentes com polipose adenomatosa familiar Pós-Retocolectomia

“…CHURCH et al (4) , observaram adenomas no trato gastrointestinal superior acima de 90%, principalmente no duodeno. VASEN et al (18) descreveram adenomas duodenais em 90% dos pacientes com PAF, e adenocarcinoma duodenal em 3% a 4%.…”

“…O rastreamento endoscópico pós-operatório para pesquisa de pólipos gastroduodenais tem mostrado incidência de 90% a 95% de pólipos, sendo que 5% desenvolvem câncer (4,5,10) . No entanto, este risco é 100 a 300 vezes maior que na população em geral, na qual o carcinoma duodenal é de ocorrência rara (3,11,12) .…”