title: "High rate of recurrent adenomatosis during endoscopic surveillance after duodenectomy in patients with familial adenomatous polyposis".
abstract: Advanced duodenal adenomatosis in patients with familial adenomatous polyposis (FAP) is associated with a significant risk of duodenal carcinoma. Duodenectomy is sometimes indicated to prevent malignant transformation or to resect established carcinomas. Advanced recurrent adenomatosis and cancer formation in the neo-duodenum after duodenectomy in FAP have been reported. The aim of this study was to describe findings during endoscopic follow-up in a cohort of FAP patients after duodenectomy, to assess the indication and whether recommendations can be made for endoscopic surveillance. All FAP patients with a history of duodenectomy performed at a single tertiary referral centre between January 2000 and July 2011 were identified. Patient characteristics and postoperative upper endoscopic procedures were reviewed retrospectively. 19 patients, with a mean age of 49 years at the time of duodenectomy were identified. One patient was lost to follow-up. The majority of patients underwent prophylactic pancreas preserving duodenectomy (95%). Mean duration of postoperative follow-up in 18 patients was 78 months with 4 postoperative endoscopies on average. An increase in neo-Spigelman stage was seen in 9 patients, after an average interval of 35 months. Overall, newly formed adenomas in the neo-duodenum were found in 14 of 18 patients (78%), after a mean of 46 months after duodenectomy. Recurrent adenomas were mostly located in close proximity to the neo-papilla. This included advanced adenomas in 7 patients, warranting enteric re-resection in 2 patients. Continued intensive endoscopic surveillance is indicated after duodenectomy in FAP, especially of the area around the bilio- and pancreatico-enteric anastomoses.
authors: Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands, y.a.alderlieste@amc.uva.nl.
authors: Yasser A
authors: YA
authors: Alderlieste
authors: Barbara A
authors: BA
authors: Bastiaansen
authors: Elisabeth M H
authors: EM
authors: Mathus-Vliegen
authors: Dirk J
authors: DJ
authors: Gouma
authors: Evelien
authors: E
authors: Dekker
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000209:etiology*; D011125:Adenomatous Polyposis Coli / Q000150:complications* / Q000601:surgery; D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D004379:Duodenal Neoplasms / Q000175:diagnosis / Q000209:etiology*; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000209:etiology*; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies
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