Frequency and severity of ileal adenomas in familial adenomatous polyposis after colectomy.
OBJECTIVE
The high cumulative risk of colorectal cancer in patients with familial adenomatous polyposis (FAP) justifies prophylactic colectomy with either ileorectal (IRA) or ileal-pouch-anal anastomosis (IPAA). Our aim was to evaluate retrospectively the frequency of and time interval to adenoma development in the ileal mucosa of patients with both types of surgery.


METHODS
Retrospective study of 44 FAP patients with IRA (n = 21) and IPAA (n = 23). All patients were followed with a standardized procedure including chromoscopy and biopsies of visible polyps. In patients with IRA, specific attention was paid to the ileal mucosa above the anastomosis.


RESULTS
In the IPAA group, 18/23 patients (78 %) presented with visible polyps [histology: 16 (70 %) had adenoma with low-grade dysplasia; 1 (4 %) had adenoma with high-grade dysplasia; 1 had normal mucosa]. The mean interval between colectomy and the diagnosis of adenoma was 4.7 +/- 3.3 years. In the IRA group, 16/21 patients (77 %) presented visible polyps in the ileal mucosa [adenoma with low-grade dysplasia in 8 patients (38 %), with high-grade dysplasia in 2 (10 %), and lymphoid nodular hyperplasia in 6]. The mean interval between colectomy and adenoma diagnosis was significantly shorter in the IPAA than in the IRA group (4.76 +/- 3.3 vs. 16.4 +/- 8.5 years, P< 0.0001).


CONCLUSIONS
Our results show a high frequency of adenomas in the ileal mucosa of patients with IPAA and IRA (74 % and 48 % respectively), with evolution into high-grade dysplasia in 6.7 % of cases.
Moussata
D
D
Hôpital Lyon Sud, Service d'Hépato-gastro-entérologie, Chemin du Grand Revoyet, Pierre Bénite, France. driffa.moussata@chu-lyon.fr
Nancey
S
S
Lapalus
M G
MG
Prost
B
B
Chavaillon
A
A
Bernard
G
G
Ponchon
T
T
Saurin
J C
JC
D000236:Adenoma / Q000453:epidemiology* / Q000473:pathology; D011125:Adenomatous Polyposis Coli / Q000150:complications / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001707:Biopsy, Needle; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D039021:Colonic Pouches / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007078:Ileal Neoplasms / Q000453:epidemiology* / Q000473:pathology; D007150:Immunohistochemistry; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011336:Probability; D016737:Proctocolectomy, Restorative; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution