Skip to main content
SpringerLink
Log in

Adenomatous polyps develop commonly in the ileal pouch of patients with familial adenomatous polyposis

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

PURPOSE: The aim of this study was to establish the prevalence of adenomatous polyps in the ileal pouch of patients with familial adenomatous polyposis. METHOD: Forty-three patients who had an ileal pouch for familial adenomatous polyposis were invited to have a careful endoscopic examination of their pouch, including dye spraying. The number of polyps was recorded, and up to ten were biopsied. In addition, four random biopsy specimens were taken from the proximal and four from the distal pouch. RESULTS: Thirty-three patients with a median age of 36 (range, 14–63) years who had a pouch (5 Kock and 28 pelvic) for a median of 7 (range, 1–19) years accepted the invitation. Twenty-one patients (64 percent) had endoscopically identified polyps, the number of polyps ranging from 1 to 100 (median, 10) and varying in size from 1 to 3 mm. Fourteen patients (42 percent) had adenomatous polyps and 4 of these also had microadenomas on random biopsies. Nine of the 14 patients with adenomas also had lymphoid polyps. Seven patients had lymphoid polyps only and two of these patients had a microadenoma on random biopsy. Four of 12 patients with no visible polyps had microadenomas in their random biopsies. The presence of adenomatous polyps (Pearson's correlation;P < 0.01) increased with the age of the pouch. In total, 20 of 33 (60 percent) patients had adenomas and or microadenomas. CONCLUSION: Adenomatous polyps occur frequently in ileal pouches. These findings are of concern, and therefore, regular surveillance seems warranted until the natural history of these adenomatous polyps is determined.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bulow S, Bulow C, Nielsen TF,et al. Centralized registration, prophylactic examination, and treatment results in improved prognosis in familial adenomatous polyposis. Results from the Danish Polyposis Register. Scand J Gastroenterol 1995;30:989–93.

    Google Scholar 

  2. Jagelman DG. Choice of operation in familial adenomatous polyposis. World J Surg 1991;15:47–9.

    Google Scholar 

  3. Soravia C, Klein L, Berk T, O'Connor BI, Cohen Z, McLeod RS. Comparison of ileal pouch anal anastomosis and ileorectal anastomosis in familial adenomatous polyposis. Dis Colon Rectum 1999;42:1028–34.

    Google Scholar 

  4. De Cosse JJ, Bulow S, Neale K,et al. Rectal cancer risk in patients treated for familial adenomatous polyposis. The Leeds Castle Polyposis Group. Br J Surg 1992;79:1372–5.

    Google Scholar 

  5. Nugent KP, Phillips RK. Rectal cancer risk in older patients with familial adenomatous polyposis and an ileorectal anastomosis: a cause for concern. Br J Surg 1992;79:1204–6.

    Google Scholar 

  6. Wu JS, McGannon EA, Church JM. Incidence of neoplastic polyps in the ileal pouch of patients with familial adenomatous polyposis after restorative proctocolectomy. Dis Colon Rectum 1998;41:552–7.

    Google Scholar 

  7. Palkar VM, deSouza LJ, Jagannath P, Naresh KN. Adenocarcinoma arising in “J” pouch after total proctocolectomy for familial polyposis coli. Indian J Cancer 1997;34:16–9.

    Google Scholar 

  8. Bassuini MM, Billings PJ. Carcinoma in an ileoanal pouch after restorative proctocolectomy for familial adenomatous polyposis. Br J Surg 1996;83:506.

    Google Scholar 

  9. von Herbay A, Stem J, Herfarth C. Pouch-anal cancer after restorative proctocolectomy for familial adenomatous polyposis. Am J Surg Pathol 1996;20:995–9.

    Google Scholar 

  10. Hoehner JC, Metcalf AM. Development of invasive adenocarcinoma following colectomy with ileoanal anastomosis for familial polyposis coli: report of a case. Dis Colon Rectum 1994;37:824–8.

    Google Scholar 

  11. Moskowitz RL, Shepherd NA, Nicholls RJ. An assessment of inflammation in the reservoir after restorative proctocolectomy with ileoanal ileal reservoir. Int J Colorectal Dis 1986;1:167–74.

    Google Scholar 

  12. Soravia C, Berk T, Haber G, Cohen Z, Gallinger S. Management of advanced duodenal polyposis in familial adenomatous polyposis. J Gastrointest Surg 1997;1:474–8.

    Google Scholar 

  13. Wu JS, Paul P, McGannon EA, Church JM. APC genotype, polyp number, and surgical options in familial adenomatous polyposis. Ann Surg 1998;227:57–62.

    Google Scholar 

  14. Nagase H, Miyoshi Y, Horii A,et al Correlation between germline mutations and the number of colorectal polyps in familial adenomatous polyposis patients. Cancer Res 1992;52:4055–7.

    Google Scholar 

  15. Paul P, Letteboer T, Gelbert L, Groden J, White R, Coppes MJ. Identical APC exon 15 mutations result in a variable phenotype in familial adenomatous polyposis. Hum Mol Genet 1993;2:925–31.

    Google Scholar 

  16. Gayther SA, Wells D, SenGupta SB,et al. Regionally clustered APC mutations are associated with a severe phenotype and occur at a high frequency in new mutation cases of adenomatous polyposis coli. Hum Mol Genet 1994;3:53–6.

    Google Scholar 

  17. Giardiello FM, Krush AJ, Petersen GM,et al. Phenotypic variability of familial adenomatous polyposis in 11 unrelated families with identical APC gene mutation. Gastroenterology 1994;106:1542–7.

    Google Scholar 

  18. Vasen HF, van der Luijt RB, Slors JF,et al. Molecular genetic tests as a guide to surgical management of familial adenomatous polyposis. Lancet 1996;348:433–5.

    Google Scholar 

  19. Nugent KP, Spigelman AD, Nicholls RJ,et al. Pouch adenomas in patients with familial adenomatous polyposis. Br J Surg 1993;80:1620.

    Google Scholar 

  20. Hermanek P. Dysplasia-carcinoma sequence, types of adenomas and early colo-rectal carcinoma. Eur J Surg Oncol 1987;13:141–3.

    Google Scholar 

  21. Iida M, Yao T, Ohsato K, Itoh H, Watanabe H. Diagnostic value of interoperative fiberscopy for small-intestinal polyps in familial adenomatous coli. Endoscopy 1980;12:161–5.

    Google Scholar 

  22. Roth JA, Logio T. Carcinoma arising in an ileostomy: an unusual complication of familial adenomatous polyposis. Cancer 1982;49:2180–4.

    Google Scholar 

  23. Primrose JN, Quirke P, Johnston D. Carcinoma of the ileostomy in a patient with familial adenomatous polyposis. Br J Surg 1988;76:384.

    Google Scholar 

  24. Suarez V, Alexander-Williams J, O'Connor HJ. Carcinoma developing in ileostomies after 25 or more years. Gastroenterology 1988;95:205–8.

    Google Scholar 

  25. Gadacz TR, McFadden DW, Gabrielson EW, Ullah A, Berman JJ. Adenocarcinoma of the ileostomy: the latent risk of cancer after colectomy for ulcerative colitis and familial polyposis. Surgery 1990;107:698–703.

    Google Scholar 

  26. Gilson TP, Sollenberger LL. Adenocarcinoma of an ileostomy in a patient with familial adenomatous polyposis: report of a case. Dis Colon Rectum 1992;35:261–5.

    Google Scholar 

  27. Johnson JA, Talton DS, Poole GV. Adenocarcinoma of a Brooke ileostomy for adenomatous polyposis coli. Am J Gastroenterol 1993;88:1122–4.

    Google Scholar 

  28. Johnson CD, White H. Colonic metaplasia with colonic-type polyps on an ileostomy stoma in polyposis coli: report of a case. Dis Colon Rectum 1988;31:405–7.

    Google Scholar 

  29. Iida M, Itoh H, Matsui T, Mibu R, Iwashita A, Fujishima M. Ileal adenomas in postcolectomy patients with familial adenomatosis coli/Gardner's syndrome: incidence and endoscopic appearance. Dis Colon Rectum 1989;32:1034–8.

    Google Scholar 

  30. Bertoni G, Sassatelli R, Nigrisoli E,et al. First observation of microadenomas in the ileal mucosa of patients with familial adenomatous polyposis. Gastroenterology 1995;109:374–80.

    Google Scholar 

  31. Shepherd NA, Jass JR, Duval I,et al. Restorative proctocolectomy with ileal reservoir: pathological and histochemical study of mucosal biopsy specimens. J Clin Pathol 1987;40:601–7.

    Google Scholar 

  32. Corfield AP, Warren BF, Bartolo DC,et al. Mucin changes in ileoanal pouches monitored by metabolic labeling and histochemistry. Br J Surg 1992;79:1209–12.

    Google Scholar 

  33. de Silva HJ, Millard PR, Kettlewell M,et al. Mucosal characteristics of pelvic ileal pouches. Gut 1991;32:61–5.

    Google Scholar 

  34. Nakahara S, Itoha H, Iida M, Iwashita A, Ohsato K. Ileal adenomas in familial polyposis coli: differences before and after colectomy. Dis Colon Rectum 1985;28:875–7.

    Google Scholar 

  35. Wolfstein I, Bat L, Neumann G. Regeneration of rectal mucosa and recurrent polyposis coli after total colectomy and ileoanal anastomosis. Arch Surg 1982;117:1241–2.

    Google Scholar 

  36. Go PM, Lens J, Bosman FT. Mucosal alterations in the reservoir of patients with Kock's continent ileostomy. Scand J Gastroenterol 1987;22:1076–80.

    Google Scholar 

  37. Lerch MM, Braun J, Harder M, Hofstadter F, Schumpelick V, Matern S. Postoperative adaptation of the small intestine after total colectomy and J-pouch-anal anastomosis. Dis Colon Rectum 1989;32:600–8.

    Google Scholar 

  38. Bayat M, Brynskov J, Dige Petersen H, Hippe E, Lonborg-Jensen H. Direct and quantitative vitamin B12 absorption measurement in patients with disorders in the distal part of the bowel. Comparison of stool spot test [SST] with whole body counting in patients with ileal pelvic reservoir, ileostomy or Crohn's disease. Int J Colorectal Dis 1994;9:68–72.

    Google Scholar 

  39. de Silva HJ, Kettlewell MG, Mortensen NJ,et al. Acute inflammation in ileal pouches. Eur J Gastroenterol Hepatol 1991;3:343–9.

    Google Scholar 

  40. Apel R, Cohen Z, Andrews CW Jr, McLeod RS, Steinhart H, Odze RD. Prospective evaluation of early morphological changes in pelvic ileal pouches. Gastroenterology 1994;107:435–43.

    Google Scholar 

  41. Clausen MR, Tvede M, Mortensen PB. Short-chain fatty acids in pouch contents from patients with and without pouchitis after ileal pouch-anal anastomosis. Gastroenterology 1992;103:1144–53.

    Google Scholar 

  42. Nasmyth DG, Godwin PG, Dixon MF,et al. Ileal ecology after pouch-anal anastomosis or ileostomy. A study of mucosal morphology, fecal bacteriology, fecal volatile fatty acids, and their interrelationship. Gastroenterology 1989;96:817–24.

    Google Scholar 

  43. Natori H, Utsunomiya J, Yamamura T, Benno Y, Uchida K. Fecal and stomal bile acid composition after ileostomy or ileoanal anastomosis in patients with chronic ulcerative colitis and adenomatosis coli. Gastroenterology 1992;102:1278–88.

    Google Scholar 

  44. Thompson-Fawcett MW, Marcus V, Redston M, Cohen Z, McLeod RS. No evidence of dysplasia in long-term ileal pouches or pouches with chronic pouchitis. Gastroenterology 1999;115:A832.

    Google Scholar 

  45. Fujimura Y, Kamoi R, Iida M. Pathogenesis of apthoid ulcers in Crohn's disease: correlative findings by magnifying colonoscopy, electron microscopy and immunohistochemistry. Gut 1996;38:724–32.

    Google Scholar 

  46. Kudo S. Endoscopic resection of flat and depressed types of early colorectal cancer. Endoscopy 1993;25:455–61.

    Google Scholar 

  47. Tonelli F, Nardi F, Bechi P, Taddei G, Gozzo P, Romagnoli P. Extracolonic polyps in familial polyposis coli and Gardner's syndrome. Dis Colon Rectum 1985;28:664–8.

    Google Scholar 

  48. Hamilton SR, Bussey HJ, Mendelsohn G. Ileal adenomas after colectomy in nine patients with adenomatous, polyposis coli/Gardner's syndrome. Gastroenterol 1979;77:1252–7.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. From the Steve Atanas Stavro Familial Colon Cancer Registry and Department of Surgery, Mt. Sinai Hospital, University of Toronto, Toronto, Canada

    M. W. Thompson-Fawcett M.B., Ch.B., Z. Cohen M.D. & R. S. McLeod M.D.

  2. From the Steve Atanas Stavro Familial Colon Cancer Registry and Department of Pathology and Laboratory Medicine, Mt. Sinai Hospital, University of Toronto, Toronto, Canada

    V. A. Marcus M.D. & M. Redston M.D.

Authors
  1. M. W. Thompson-Fawcett M.B., Ch.B.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. V. A. Marcus M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Redston M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Z. Cohen M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R. S. McLeod M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Mark Thompson-Fawcett was supported by the Axcan Pharma Inflammatory Bowel Disease Research Fellowship and a research grant from the International Organization for Inflammatory Bowel Disease.

Poster presentation at The American Society of Colon and Rectal Surgeons' 100th Anniversary and Tripartite Meeting, Washington, D.C., May 1 to 6, 1999, and the Royal Australian College of Surgeons Scientific Congress, Auckland, New Zealand, May 10 to 14, 1999.

About this article

Cite this article

Thompson-Fawcett, M.W., Marcus, V.A., Redston, M. et al. Adenomatous polyps develop commonly in the ileal pouch of patients with familial adenomatous polyposis. Dis Colon Rectum 44, 347–353 (2001). https://doi.org/10.1007/BF02234731

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02234731

Key words

Search

Navigation