Endoscopic management of familial adenomatous polyposis in patients refusing colectomy.
OBJECTIVE
Colectomy protects against colorectal cancer in familial adenomatous polyposis (FAP); however, some patients with FAP refuse surgery. The aim of this study was to evaluate the feasibility and safety of endoscopic management of these patients.


METHODS
A retrospective review of medical records was performed to identify adult patients with FAP who refused colectomy and were managed by repeated colonoscopies to remove numerous polyps between 2001 and 2012. Polyps were removed by hot snare polypectomy or endoscopic mucosal resection. Polyps of < 10 mm in size and without endoscopic features suggesting cancer were discarded without histological examination; the remaining polyps were examined histologically.


RESULTS
Of the 95 eligible patients, five (5.3 %) were excluded. The remaining 90 patients (median age at first visit 29 years [range 16 - 68 years]; 46 males) were followed for a median of 5.1 years (interquartile range [IQR] 3.3 - 7.3 years). During this period, a total of 55 701 polyps were resected without adverse events such as bleeding or perforation. The median numbers of endoscopic treatment sessions and polyps removed per patient were 8 (IQR 6 - 11) and 475 (IQR 211 - 945), respectively. Five patients had noninvasive carcinoma (Category 4.2 according to the revised Vienna classification), detected within 10 months from the start of the follow-up period. All of these patients were treated endoscopically, without signs of recurrence during a median follow-up of 4.3 years (IQR 2.0 - 7.1 years). No invasive colorectal cancer was recorded during the study period. Two patients (2.2 %) underwent colectomy because the polyposis phenotype had changed to dense polyposis.


CONCLUSIONS
Endoscopic management of FAP is feasible and safe in the medium term.
Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Hideki
H
Ishikawa
Division of Cancer Prevention Research, National Cancer Center Research Institute, Tokyo, Japan.
Michihiro
M
Mutoh
Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
Takeo
T
Iwama
Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan.
Sadao
S
Suzuki
Department of Gastroenterology, Takarazuka Municipal Hospital, Hyogo, Japan.
Takashi
T
Abe
Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
Yoji
Y
Takeuchi
Department of Food Nutrition, Faculty of Agriculture, Ryukoku University, Shiga, Japan.
Tomiyo
T
Nakamura
Department of Therapeutic Oncology, Kyoto University, Kyoto, Japan.
Yasumasa
Y
Ezoe
Division of Cancer Prevention Research, National Cancer Center Research Institute, Tokyo, Japan.
Gen
G
Fujii
Graduate Division of Nutritional and Environmental Sciences, University of Shizuoka, Shizuoka, Japan.
Keiji
K
Wakabayashi
Endoscopy Center, National Cancer Center Hospital, Tokyo, Japan.
Takeshi
T
Nakajima
Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Toshiyuki
T
Sakai
D011125:Adenomatous Polyposis Coli / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D003082:Colectomy; D003113:Colonoscopy; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult