title: High resolution endoscopy and the additional value of chromoendoscopy in the evaluation of duodenal adenomatosis in patients with familial adenomatous polyposis.
abstract: OBJECTIVE
  Duodenal polyposis occurs in approximately 90 % of patients with familial adenomatous polyposis (FAP) and 5 % - 10 % develop duodenal cancer. Novel imaging techniques may improve evaluation of duodenal polyposis using the Spigelman classification. We aimed to analyze the value of high resolution endoscopy (HRE) and the additional value of chromoendoscopy in the evaluation of duodenal polyposis in FAP.
  
  
  METHODS
  43 FAP patients scheduled for surveillance endoscopy in two academic centers underwent gastroduodenoscopy with HRE forward- and side-viewing devices. After number and size of adenomas had been scored, indigo carmine 0.5 % was sprayed onto the mucosa, polyps were scored again and biopsies taken from the larger lesions. Subsequently, Spigelman classifications were assessed for pre- and post-staining.
  
  
  RESULTS
  Before staining, a median of 16 adenomas per patient were detected compared with 21 adenomas after staining ( P = 0.02). Staining led to upgrading of Spigelman stage in 5/43 patients (12 %). Using the side-viewing endoscope, ampullary enlargement was detected in 22 patients (51 %) of whom 18 (42 %) had histologically confirmed ampullary adenomas.
  
  
  CONCLUSIONS
  HRE has raised the quality of endoscopic imaging considerably. Consequently, re-evaluation of the original Spigelman classification system seems advisable. Chromoendoscopy further increases detection of duodenal adenomas in FAP but without considerable change in Spigelman stage. Ampullary adenomas are commonly found in FAP and are best visualized using a side-viewing endoscope. Therefore, a combination of forward-viewing HRE and chromoendoscopy with side-viewing endoscopy for the periampullary region seems useful for surveillance of duodenal adenomatosis in FAP.
authors: Department of Gastroenterology and Hepatology, Academic Medical Centre Amsterdam, The Netherlands. e.dekker@amc.uva.nl
authors: E
authors: E
authors: Dekker
authors: K S
authors: KS
authors: Boparai
authors: J W
authors: JW
authors: Poley
authors: E M
authors: EM
authors: Mathus-Vliegen
authors: G J A
authors: GJ
authors: Offerhaus
authors: E J
authors: EJ
authors: Kuipers
authors: P
authors: P
authors: Fockens
authors: J
authors: J
authors: Dees
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000473:pathology; D011125:Adenomatous Polyposis Coli / Q000150:complications* / Q000473:pathology; D000328:Adult; D000368:Aged; D004379:Duodenal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D004384:Duodenoscopy / Q000379:methods*; D006801:Humans; D007089:Image Enhancement; D007203:Indigo Carmine; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012680:Sensitivity and Specificity; D013194:Staining and Labeling; D055815:Young Adult
chemical_list: D007203:Indigo Carmine