title: Surveillance and treatment of duodenal adenomatosis in familial adenomatous polyposis.
abstract: OBJECTIVE
  Patients with familial adenomatous polyposis (FAP) are at increased risk for duodenal cancer whereas colorectal cancer is largely prevented by prophylactic colectomy. We analyzed the results of endoscopic surveillance and different treatment modalities of duodenal adenomatosis in patients with FAP.
  
  
  METHODS
  Data on endoscopies, histopathological examinations, and surgical therapies were collected from the medical histories of 129 patients with FAP. The cumulative incidences of duodenal adenomatosis and severe dysplasia and cancer were calculated using Kaplan-Meier analysis.
  
  
  RESULTS
  By the age of 60 years, the cumulative incidence was 80% for any adenomatosis and 23% for severe dysplasia or cancer. Duodenal cancer was observed in six patients (4.7%). Fifteen endoscopic excisions in 14 patients, and 19 open duodenotomies in 17 patients were carried out. Later, pancreaticoduodenectomy was undertaken in six (35.3%) of these 17 patients. Altogether, 12 patients (9.3%) underwent pancreaticoduodenectomy. Except for one patient, the indication for surgery was based on follow-up endoscopies, and none of these patients died of duodenal cancer. No postoperative deaths occurred. Seven patients (58.3%) had major complications, four (33.3%) of which were surgical.
  
  
  CONCLUSIONS
  The high incidence of severe dysplasia and cancer in duodenal polyps suggests that endoscopic surveillance is essential. Endoscopic polypectomies under sedation anesthesia have partly replaced open duodenotomies. High-risk patients with Spigelman IV adenomatosis or adenomas with persisting severe dysplasia should undergo surgery with pylorus-preserving pancreaticoduodenectomy before invasive cancer develops.
authors.affiliation: Department of Surgery, Helsinki University Central Hospital, Finland. anna.lepisto@hus.fi
authors.forename: A
authors.initials: A
authors.lastname: Lepistö
authors.forename: T
authors.initials: T
authors.lastname: Kiviluoto
authors.forename: J
authors.initials: J
authors.lastname: Halttunen
authors.forename: H J
authors.initials: HJ
authors.lastname: Järvinen
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000150:complications* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy; D004379:Duodenal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D004384:Duodenoscopy; D005260:Female; D006801:Humans; D015994:Incidence; D007417:Intestinal Polyps / Q000150:complications* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies; D012720:Severity of Illness Index