Gastroduodenal involvement in patients with familial adenomatous polyposis. Prospective study of the nature and evolution of polyps: evaluation of the treatment and surveillance methods applied.
OBJECTIVE
Analysis of the incidence rate and the evolution of duodenal and stomach polyps in our familial adenomatous polyposis (FAP) patients, the suitability of the surveillance method and the cancer-preventing treatment applied and the analysis of the complications arising from each procedure employed.


METHODS
Twenty-nine patients diagnosed with FAP underwent study and endoscopic surveillance of the upper digestive tract. Front-view and side-view endoscopies were used. Papillary biopsies were performed even when the papilla were macroscopically normal. The Spigelman classification was used to determine the seriousness of the condition and to establish the surveillance and treatment intervals.


RESULTS
Duodenal and/or papillary polyps were presented by 79.3% of the patients. Endoscopic polypectomy was performed in 13 patients with duodenal polyps. Endoscopic polypectomies for the papilla were performed in all patients. One patient required a cephalic duodenopancreatectomy and another endoscopic ampullectomy. The condition did not become cancerous in any of the patients who underwent surveillance. We report two complications arising from treatment: one postpolypectomy haemorrhage and one stenosis of the biliary-enteric anastomosis after cephalic duodenopancreatectomy.


CONCLUSIONS
Our study shows a high incidence rate of duodenal polyps in FAP patients. A minute examination of the duodenum and papilla is necessary, using side-view endoscopes and duodenal papilla biopsies even when papilla appears to be normal. None of the patients having completed the surveillance and the prescribed treatment developed cancer and all have a low Spigelman score. This method, therefore, seems to be adequate for the treatment and surveillance of duodenal polyps.
Department of Gastroenterology, Virgen del Rocío University Hospital, Seville, Spain. ccordero994@gmail.com
Carmen
C
Cordero-Fernández
Marta
M
Garzón-Benavides
Angeles
A
Pizarro-Moreno
Raul
R
García-Lozano
Jose Luis
JL
Márquez-Galán
Teofilo
T
López Ruiz
Salvador
S
Sobrino
Juan Manuel
JM
Bozada
Ovidio Belda
OB
Laguna
D011125:Adenomatous Polyposis Coli / Q000473:pathology* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D018450:Disease Progression; D004379:Duodenal Neoplasms / Q000473:pathology* / Q000601:surgery; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult