Advertisement

Surgical Endoscopy

, Volume 10, Issue 4, pp 418–421 | Cite as

Gastroduodenal polyps in familial adenomatous polyposis

  • P. W. Marcello
  • H. J. Asbun
  • M. C. Veidenheimer
  • R. L. Rossi
  • P. L. Roberts
  • S. N. Fine
  • J. A. Coller
  • J. J. Murray
  • D. J. SchoetzJr.
Original Articles

Abstract

Background: Malignant degeneration of gastroduodenal polyps has been noted in patients with familial adenomatous polyposis. To evaluate this problem further, patients with familial adenomatous polyposis were contacted and offered upper gastrointestinal tract endoscopy.

Methods: A prospective endoscopic examination was performed in 42 patients.

Results: The median age of patients at endoscopy was 35 years. The duration of known familial adenomatous polyposis at the time of endoscopy was 8 years. Polyps were visualized in 21 patients (50%). Gastric polyps were seen in 14 patients (33%), duodenal polyps were seen in 11 patients (26%), and ampullary polyps were seen in 7 patients (17%). Nine patients (43%) had polyps in more than one site. Adenomatous change was noted in 73% of duodenal lesions and in only 14% of gastric polyps. Surgical intervention was required in four patients; one patient had an early ampullary carcinoma, and three patients had severe dysplasia involving the duodenum or ampulla. All four patients had undergone a previous screening examination, results of which were normal in three patients. Compared with other patients, these four patients were older (median age, 58 years; p=0.02) and had a longer duration of disease (median duration, 25 years; p=0.002).

Conclusions: All patients with familial adenomatous polyposis require lifelong endoscopic surveillance to detect malignant degeneration, which may appear later in life.

Key words

Familial adenomatous polyposis Endoscopy Surveillance Gastroduodenal polyps and carcinoma 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Alexander JR, Andrews JM, Buchi KN, Lee RG, Becker JM, Burt RW (1989) High prevalence of adenomatous polyps of the duodenal papilla in familial adenomatous polyposis. Dig Dis Sci 34: 167–170Google Scholar
  2. 2.
    Arvanitis ML, Jagelman DG, Fazio VW, Lavery IC, McGannon E (1990) Mortality in patients with familial adenomatous polyposis. Dis Colon Rectum 33: 639–642Google Scholar
  3. 3.
    Asbun HJ, Rossi RL, Munson JL (1993) Local ampullary resection for ampullary tumors. Is there a place for it? Arch Surg 128: 515–520Google Scholar
  4. 4.
    Beckwith PS, van Heerden JA, Dozios RR (1991) Prognosis of symptomatic duodenal adenomas in familial adenomatous polyposis. Arch Surg 126: 825–828Google Scholar
  5. 5.
    Botet JF, Lightdale C (1992) Endoscopic ultrasonography of the upper gastrointestinal tract. Radiol Clin North Am 30: 1067–1083Google Scholar
  6. 6.
    Bulow S, Skov Olsen P, Poulsen SS, Kirkegaard P (1988) Is epidermal growth factor involved in development of duodenal polyps in familial polyposis coli? Am J Gastroenterol 83: 404–406Google Scholar
  7. 7.
    Caletti G, Odegaard S, Rösch T, Sivak MV, Tio TL, Yasuda K (1994) Endoscopic ultrasonography (EUS): a summary of the conclusions of the Working Party for the Tenth World Congress of Gastroenterology, Los Angeles, California October, 1994. The Working Group on Endoscopic Ultrasonography. Am J Gastroenterol 89(8 Suppl): S138-S143Google Scholar
  8. 8.
    Church JM, McGannon E, Hull-Boiner S, Sivak MV, Van Stolk R, Jagelman DG, Fazio VW, Oakley JR, Lavery IC, Milsom JW (1992) Gastroduodenal polyps in patients with familial adenomatous polyposis. Dis Colon Rectum 35: 1170–1173Google Scholar
  9. 9.
    Gahtan V, Nochomovitz LE, Robinson AM, Garcia VF, Smith LE (1989) Gastroduodenal polyps in familial polyposis coli. Am Surg 55: 278–280Google Scholar
  10. 10.
    Iwama T, Mishima Y, Utsunomiya J (1993) The impact of familial adenomatous polyposis on the tumorigenesis and mortality at the several organs: its rational treatment. Ann Surg 217: 101–108Google Scholar
  11. 11.
    Jagelman DG, DeCosse JJ, Bussey HJ (1988) Upper gastrointestinal cancer in familial adenomatous polyposis. Lancet 1: 1149–1151Google Scholar
  12. 12.
    Kurtz RC, Sternberg SS, Miller HH, DeCosse JJ (1987) Upper gastrointestinal neoplasia in familial polyposis. Dig Dis Sci 32: 459–465Google Scholar
  13. 13.
    Offerhaus GJA, Giardiello FM, Krush AJ, Booker SV, Tersmette AC, Kelley NC, Hamilton SR (1992) The risk of upper gastrointestinal cancer in familial adenomatous polyposis. Gastroenterology 102: 1980–1982Google Scholar
  14. 14.
    Rhodes M, Bradburn DM (1992) Overview of screening and management of familial adenomatous polyposis. Gut 33: 125–131Google Scholar
  15. 15.
    Sarre RG, Frost AG, Jagelman DG, Petras RE, Sivak MV, McGannon E (1987) Gastric and duodenal polyps in familial adenomatous polyposis: a prospective study of the nature and prevalence of upper gastrointestinal polyps. Gut 28: 306–314Google Scholar
  16. 16.
    Seow-Choen F, Ho JMS, Wong J, Goh HS (1992) Gross and histological abnormalities of the foregut in familial adenomatous polyposis: a study from a South East Asian registry. Int J Colorect Dis 7: 177–183Google Scholar
  17. 17.
    Shemesh E, Bat L (1985) A prospective evaluation of the upper gastrointestinal tract and periampullary region in patients with Gardner syndrome. Am J Gastroenterol 80: 825–827Google Scholar
  18. 18.
    Spigelman AD, Granowska M, Phillips RK (1991) Duodeno-gastric reflux and gastric adenomas: a scintigraphic study in patients with familial adenomatous polyposis. J R Soc Med 84: 476–478Google Scholar
  19. 19.
    Spigelman AD, Owen RW, Hill MJ, Phillips RK (1991) Biliary bile acid profiles in familial adenomatous polyposis. Br J Surg 78: 321–325Google Scholar
  20. 20.
    Spigelman AD, Williams CB, Talbot IC, Domizio P, Phillips RK (1989) Upper gastrointestinal cancer in patients with familial adenomatous polyposis. Lancet 2: 783–785Google Scholar

Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • P. W. Marcello
    • 1
  • H. J. Asbun
    • 1
  • M. C. Veidenheimer
    • 1
  • R. L. Rossi
    • 1
  • P. L. Roberts
    • 1
  • S. N. Fine
    • 1
  • J. A. Coller
    • 1
  • J. J. Murray
    • 1
  • D. J. SchoetzJr.
    • 1
  1. 1.Departments of Colon and Rectal Surgery, General Surgery, and GastroenterologyLahey Hitchcock Medical CenterBurlingtonUSA

Personalised recommendations