title: Cap-assisted forward-viewing endoscopy to visualize the ampulla of Vater and the duodenum in patients with familial adenomatous polyposis.
abstract: Background and study aimsGuidelines recommend surveillance endoscopy with both forward- and side-viewing endoscopes to identify duodenal and ampullary adenomas in patients with familial adenomatous polyposis (FAP). We hypothesized that both the duodenum and the ampulla of Vater can be completely visualized during cap-assisted forward-viewing endoscopy.Patients and methodsA total of 40 patients with FAP underwent forward-viewing endoscopy with a short cap attached to the tip of the gastroscope, with the aim of visualizing both the duodenum and the ampulla of Vater. If unsuccessful, the procedure was followed by a side-viewing endoscopy. Adverse events were reported.ResultsThe duodenum, including the ampulla of Vater, was completely visualized using the cap in 38/40 patients (95.0 %). The ampulla could not be visualized using the cap in two patients, both of whom underwent additional side-viewing endoscopy, which was successful. No adverse events occurred.ConclusionsThis study showed that cap-assisted endoscopy can be used effectively and safely to visualize both the duodenum and the ampulla of Vater in patients with FAP. This practice might reduce burden, time, and costs of an additional side-viewing endoscopy.
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: Frank G J
authors.initials: FGJ
authors.lastname: Kallenberg
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: Barbara A J
authors.initials: BAJ
authors.lastname: Bastiaansen
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: Evelien
authors.initials: E
authors.lastname: Dekker
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000473:pathology; D011125:Adenomatous Polyposis Coli / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D014670:Ampulla of Vater / Q000473:pathology; D003138:Common Bile Duct Neoplasms / Q000175:diagnosis / Q000473:pathology; D004379:Duodenal Neoplasms / Q000175:diagnosis / Q000473:pathology; D004386:Duodenum / Q000473:pathology; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D016896:Treatment Outcome