title: Endoscopic treatment of severe duodenal polyposis as an alternative to surgery for patients with familial adenomatous polyposis.
abstract: BACKGROUND
  Patients with familial adenomatous polyposis (FAP) and severe (stage IV) duodenal polyposis are candidates for pancreaticoduodenectomy, which has high morbidity. Little information is available about the feasibility of therapeutic endoscopy for these patients.
  
  
  OBJECTIVE
  To evaluate the long-term efficiency and risks of endoscopic therapy.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  A 2-referral center long-term cohort study.
  
  
  METHODS
  Thirty-five FAP patients (15 men, mean age 48 years) presenting with stage IV duodenal polyposis were included. Patients had a mean Spigelman classification score of 9.8 points (range 9-12 points) at their first examination.
  
  
  METHODS
  Patients underwent a surveillance endoscopy, including lateral and axial viewing with chromoendoscopy while under sedation, along with 7 ± 4.8 therapeutic endoscopic sessions during a follow-up period of 9 ± 4.5 years (range 1-19 years) after their first endoscopy.
  
  
  METHODS
  Treatment modalities, adverse events, and efficiency (evolution of the Spigelman score) were reviewed.
  
  
  RESULTS
  A total of 245 therapeutic endoscopies were performed and 15 adverse events (6%) occurred. During the follow-up period, Spigelman scores decreased in 95% of patients by 6 ± 2.2 points (P = .002). Modeling analysis showed that the mean Spigelman score decreased by 60% after 150 months.
  
  
  CONCLUSIONS
  Retrospective study and the duration of the follow-up, even though this is the longest follow-up reported in medical literature.
  
  
  CONCLUSIONS
  Endoscopic treatment of severe duodenal polyposis in patients with FAP produces few adverse events and allows efficient downstaging of the polyposis. Long-term follow-up data did not reveal a high risk of invasive duodenal cancer in these patients.
authors.affiliation: Gastroenterology Department, Lyon Sud Hospital, Pierre Benite, France.
authors.forename: Driffa
authors.initials: D
authors.lastname: Moussata
authors.affiliation: Gastroenterology Department, Edouard Herriot Hospital, Lyon, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Napoleon
authors.affiliation: Gastroenterology Department, Edouard Herriot Hospital, Lyon, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Lepilliez
authors.affiliation: Statistics Department, Lyon Civil Hospital, Lyon, France.
authors.forename: Amna
authors.initials: A
authors.lastname: Klich
authors.affiliation: Statistics Department, Lyon Civil Hospital, Lyon, France.
authors.forename: René
authors.initials: R
authors.lastname: Ecochard
authors.affiliation: Gastroenterology Department, Edouard Herriot Hospital, Lyon, France.
authors.forename: Marie-Georges
authors.initials: MG
authors.lastname: Lapalus
authors.affiliation: Gastroenterology Department, Lyon Sud Hospital, Pierre Benite, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Nancey
authors.affiliation: Gastroenterology Department, Lyon Sud Hospital, Pierre Benite, France.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Cenni
authors.affiliation: Gastroenterology Department, Edouard Herriot Hospital, Lyon, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Ponchon
authors.affiliation: Gastroenterology Department, Edouard Herriot Hospital, Lyon, France.
authors.forename: Jean-Alain
authors.initials: JA
authors.lastname: Chayvialle
authors.affiliation: Gastroenterology Department, Lyon Sud Hospital, Pierre Benite, France; Gastroenterology Department, Edouard Herriot Hospital, Lyon, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Saurin
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000601:surgery*; D000328:Adult; D057908:Argon Plasma Coagulation / Q000379:methods; D015331:Cohort Studies; D004379:Duodenal Neoplasms / Q000601:surgery*; D004386:Duodenum / Q000601:surgery*; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult