Management of Duodenal Adenomas in 98 Patients with Familial Adenomatous Polyposis

Heiskanen, Ilkka; Kellokumpu, Ilmo; Järvinen, Heikki

doi:10.1055/s-1999-41

Cited by 127 publications

(103 citation statements)

References 18 publications

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“…According to the Western reports, duodenal adenomas can be found in 30-70% of FAP patients and the lifetime risk of these lesions approaches 100%. 20 The incidence of duodenal cancer is rare, about 0.01-0.04% in general population, 21 but FAP patients have a 100-330 fold higher risk of duodenal cancer compared with the general population. 16 Bülow et al 15 reported the cumulative risk of developing duodenal cancer in FAP is about 4.5% at age of 57.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Gastric and Duodenal Polyps and Risk Factors for Duodenal Neoplasm in Korean Patients with Familial Adenomatous Polyposis

Park¹,

Ryu²,

Park³

et al. 2011

Gut Liver

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Background/Aims: The prevalence of gastric polyps, duodenal adenoma and duodenal cancer has been reported as being high among familial adenomatous polyposis (FAP) patients, but there have been no reports of this association in Korea. This study evaluated the prevalence of gastric and duodenal polyps and risk factors for duodenal neoplasm in FAP patients in Korea. Methods: We reviewed both initial and follow-up endoscopic results from FAP patients. We also investigated the treatment modality of duodenal adenomas and analyzed the risk factors of duodenal neoplasms by logistic regression analysis. Results: A total of 148 patients with FAP underwent esophagogastroduodenoscopy (EGD), and the fi ndings were as follows: gastric polyp 39.9% (fundic gland polyp 25.7% and gastric adenoma 14.2%), duodenal adenoma 15.5%, gastric cancer 2.7%, and duodenal cancer 0.7%. There were two cases of gastric cancer that developed from benign gastric polyps. There were progressions of duodenal adenomatosis during follow-up, and some degree of relapse occurred after endoscopic resection. Patients with gastric polyps showed a correlation with the occurrence of duodenal neoplasm (odds ratio, 2.814; p=0.024). Conclusions: In Korean FAP patients, gastric cancer was detected more frequently, but fundic gland polyps, duodenal adenoma and duodenal cancer were detected less frequently than in Western patients. FAP patients with gastric polyps should undergo regular EGD, particularly for the early detection of duodenal neoplasia. (Gut Liver 2011;5:46-51) Key Words: Familial adenomatous polyposis; Duodenal cancer; Polyps; Adenomas; Gastric cancer INTRODUCTIONFamilial adenomatous polyposis (FAP) is characterized by the presence of at least one-hundred colorectal polyps and an earlyprogression to the colon cancer. Duodenum is the second most commonly affected site of polyp development in FAP patients. 1Duodenal polyps developed in FAP patients are adenomatous polyps, known as pre-cancerous lesions for duodenal adenocarcinoma.2 While prophylactic proctocolectomy has decreased the proportion of colorectal cancer as a cause of death in FAP patients, duodenal cancer has become a more important cause of death for these patients. 3,4 Therefore, endoscopic surveillance is important for the early detection of duodenal cancer and can improve the prognosis of FAP patients. 5The stomach is also known as a common site of polyps in FAP patients. Fundic gland polyps are the most prevalent gastric lesions, followed by adenomatous polyps. 6 In general, gastric cancer arises from adenomatous polyps via the adenomacarcinoma sequence, but several recent reports have shown that gastric adenocarcinoma can be developed from fundic gland polyp in FAP patients. [7][8][9] In this study, we investigated the prevalence of gastric polyps and adenocarcinoma, the changing pattern through follow-up endoscopy and the precancerous possibility of gastric polyp in FAP patients. Also, we described the prevalence of duodenal polyps and adenocarcinoma, progression through follow-up...

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Section: Discussionmentioning

confidence: 99%

Prevalence of Gastric and Duodenal Polyps and Risk Factors for Duodenal Neoplasm in Korean Patients with Familial Adenomatous Polyposis

Park¹,

Ryu²,

Park³

et al. 2011

Gut Liver

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“…Die operative Duodenotomie und Polypektomie kann wegen der hohen Rezidivrate nicht empfohlen werden [321,322]. Prinzipiell lässt sich auch nach extensivem chirurgischem Vorgehen das Wiederauftreten von Adenomen nicht verhindern [321].…”

Section: Level Of Evidence 1cunclassified

S3-Leitlinie – Kolorektales Karzinom

Schmiegel

Buchberger

Follmann³

et al. 2017

Z Gastroenterol

151

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“…Surgical treatments including ampullectomy, duodenectomy, and pancreatico-duodenectomy appear effective for cancer prevention but are associated with significant procedureassociated risks (7,11). Medical treatment using the cyclooxygenase (COX) inhibitors sulindac and celecoxib has proven less effective in the duodenum than the colorectum (12)(13)(14)(15), but a recent trail of combined COX and EGFR inhibition with sulindac and erlotinib demonstrated promising short-term effects on duodenal polyp burden (16).…”

Section: Introductionmentioning

confidence: 99%

Burden and Profile of Somatic Mutation in Duodenal Adenomas from Patients with Familial Adenomatous- and MUTYH-associated Polyposis

Thomas

Hurley

Meuser

et al. 2017

Clinical Cancer Research

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Purpose: Duodenal polyposis and cancer are important causes of morbidity and mortality in familial adenomatous polyposis (FAP) and MUTYH-associated polyposis (MAP). This study aimed to comprehensively characterize somatic genetic changes in FAP and MAP duodenal adenomas to better understand duodenal tumorigenesis in these disorders.Experimental Design: Sixty-nine adenomas were biopsied during endoscopy in 16 FAP and 10 MAP patients with duodenal polyposis. Ten FAP and 10 MAP adenomas and matched blood DNA samples were exome sequenced, 42 further adenomas underwent targeted sequencing, and 47 were studied by array comparative genomic hybridization. Findings in FAP and MAP duodenal adenomas were compared with each other and to the reported mutational landscape in FAP and MAP colorectal adenomas.Results: MAP duodenal adenomas had significantly more protein-changing somatic mutations (P ¼ 0.018), truncating mutations (P ¼ 0.006), and copy number variants (P ¼ 0.005) than FAP duodenal adenomas, even though MAP patients had lower Spigelman stage duodenal polyposis. Fifteen genes were significantly recurrently mutated. Targeted sequencing of APC, KRAS, PTCHD2, and PLCL1 identified further mutations in each of these genes in additional duodenal adenomas. In contrast to MAP and FAP colorectal adenomas, neither exome nor targeted sequencing identified WTX mutations (P ¼ 0.0017).Conclusions: The mutational landscapes in FAP and MAP duodenal adenomas overlapped with, but had significant differences to those reported in colorectal adenomas. The significantly higher burden of somatic mutations in MAP than FAP duodenal adenomas despite lower Spigelman stage disease could increase cancer risk in the context of apparently less severe benign disease.

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Management of Duodenal Adenomas in 98 Patients with Familial Adenomatous Polyposis

Abstract: 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.

Cited by 127 publications

References 18 publications

Prevalence of Gastric and Duodenal Polyps and Risk Factors for Duodenal Neoplasm in Korean Patients with Familial Adenomatous Polyposis

Prevalence of Gastric and Duodenal Polyps and Risk Factors for Duodenal Neoplasm in Korean Patients with Familial Adenomatous Polyposis

S3-Leitlinie – Kolorektales Karzinom

Burden and Profile of Somatic Mutation in Duodenal Adenomas from Patients with Familial Adenomatous- and MUTYH-associated Polyposis

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