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Endoscopic management of familial adenomatous polyposis targeting colorectal lesions greater than 5 mm in size: a single-center retrospective study

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Abstract

Preserving the colon while preventing colorectal cancer is challenging in patients with familial adenomatous polyposis. Although prophylactic colectomy is the current standard of care, some patients with familial adenomatous polyposis may wish to postpone colectomy as long as polyposis can be managed by endoscopic resection. This study examined our endoscopic management and prognostic results for patients with familial adenomatous polyposis who refused to undergo colectomy. We retrospectively analyzed the data of 12 patients with familial adenomatous polyposis treated at our hospital between January 1995 and December 2020. All patients opted to postpone prophylactic colectomy although they had significant polyp burdens and underwent endoscopic management, in which colorectal polyps sized > 5 mm were thoroughly resected during baseline colonoscopies and subsequently, newly arising colorectal polyps sized > 5 mm were periodically resected during surveillance colonoscopies. Patients (median age, 33 years) were followed up for a median of 5.2 years. The median number of colonoscopies and resected lesions per patient was 2 and 14 at baseline as well as, 9 and 32 during surveillance, respectively. The interval between colonoscopies was 1.0 and 7.0 months for baseline and surveillance, respectively. The colons of all 12 patients were preserved, and no invasive colorectal cancer developed. In 10 patients, 35 cases of high-grade dysplasia were observed and managed by endoscopic resection. Repeated endoscopic resection of colorectal polyps sized > 5 mm with appropriate surveillance may be an alternative form of endoscopic management for patients with familial adenomatous polyposis wishing to postpone colectomy.

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Data availability

The data supporting this study’s findings are available from the corresponding author, TM, upon reasonable request.

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Funding

This work was supported in part by The National Cancer Center Research and Development Fund (31-A-2).

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Authors and Affiliations

  1. Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, 6-5-1Kashiwa-shi, KashiwanohaChiba, Japan

    Tatsuro Murano, Hiroaki Ikematsu, Kensuke Shinmura, Kei Okumura, Kenji Takashima, Keiichiro Nakajo, Tomohiro Kadota, Yusuke Yoda, Yasuhiro Oono & Tomonori Yano

  2. Department of Genetic Medicine and Services, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa-shi, Chiba, Japan

    Takeshi Kuwata

  3. Department of Genetic Medicine and Services, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan

    Mineko Ushiama & Teruhiko Yoshida

Authors
  1. Tatsuro Murano
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  2. Hiroaki Ikematsu
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  3. Kensuke Shinmura
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  11. Yusuke Yoda
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  12. Yasuhiro Oono
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  13. Tomonori Yano
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Contributions

Conception and design: TM, HI, KS; analysis and interpretation of the data: TM, KO, HI, KS (clinical data), TK, MU, TY (genetic data); drafting of the article: TM critical revision of the article for important intellectual content: HI, KS, TK, TY; final approval of the article: KT, KN, YY, YO.

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Correspondence to Tatsuro Murano.

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The authors have no competing interests to declare that are relevant to the content of this article.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study protocol was approved by the Institutional Review Board of our hospital (Registration Number 2013-303/2017-434).

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Murano, T., Ikematsu, H., Shinmura, K. et al. Endoscopic management of familial adenomatous polyposis targeting colorectal lesions greater than 5 mm in size: a single-center retrospective study. Familial Cancer 22, 83–89 (2023). https://doi.org/10.1007/s10689-022-00308-x

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