title: Surveillance of duodenal adenomas in familial adenomatous polyposis reveals high cumulative risk of advanced disease.
abstract: OBJECTIVE
  The development of high-grade dysplasia (HGD) on duodenal or jejunal adenomas and of late-stage (stage IV) duodenal polyposis are major clinical events for familial adenomatous polyposis (FAP) patients. Our aim was to determine their respective frequency, risk factors, and cumulative risk.
  
  
  METHODS
  A prospective, optimized, endoscopic surveillance protocol was applied to 58 FAP patients in a university hospital. The number, size, and histology of duodenojejunal polyps were assessed, and the Spigelman's score was calculated at each endoscopy. Cox regression and linear regression analysis were used to determine risk factors for HGD development and the cumulative risk of stage IV duodenal polyposis, respectively.
  
  
  RESULTS
  During a median (+/- standard deviation) follow-up of 47.9 +/- 15.6 months, 35 patients with at least two consecutive examinations had 107 duodenojejunal examinations. The Spigelman's score increased in 21 patients (60.0%), and HGD developed in 12 patients (34.2%). High initial Spigelman's score (> 7 points), but not age or APC mutation site, was a risk factor for HGD development. Estimated cumulative risk of developing stage IV duodenal polyposis was of 42.9% at age 60 (95% CI, 35.7% to 50.0%) and 50.0% at age 70 (95% CI, 42.9% to 57.1%).
  
  
  CONCLUSIONS
  This prospective series shows a higher duodenal polyposis progression rate and cumulative risk of late-stage (stage IV) duodenal polyposis in FAP patients compared with previous series. These results suggest that current modalities for surveillance and management of these patients need revision.
authors.affiliation: Service d'Hepatogastroenterologie, Pavillon I, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69437 Lyon cedex 03, France. saurin@lyon.inserm.fr
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Saurin
authors.forename: Christelle
authors.initials: C
authors.lastname: Gutknecht
authors.forename: Bertrand
authors.initials: B
authors.lastname: Napoleon
authors.forename: Annick
authors.initials: A
authors.lastname: Chavaillon
authors.forename: René
authors.initials: R
authors.lastname: Ecochard
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Scoazec
authors.forename: Thierry
authors.initials: T
authors.lastname: Ponchon
authors.forename: Jean-Alain
authors.initials: JA
authors.lastname: Chayvialle
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D011125:Adenomatous Polyposis Coli / Q000175:diagnosis* / Q000503:physiopathology; D000328:Adult; D018450:Disease Progression; D004379:Duodenal Neoplasms / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D004384:Duodenoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors