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Gastroduodenal lesions in familial adenomatous polyposis

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Abstract

Prophylactic colectomy is generally recommended for patients with familial adenomatous polyposis (FAP) who are inevitably affected with large bowel cancer. After prophylactic colectomy has been performed, gastrointestinal malignancy is the leading cause of death. Duodenal adenomas are found in patients with FAP and the adenoma-carcinoma sequence exists in the FAP duodenum, suggesting that treatment of duodenal polyps might be beneficial. Several methods of treatment for duodenal lesions in patients with FAP have been reported, but the current treatment options are not ideal. The nonsteroid anti-inflammatory drugs, sulindac and aspirin, are used for chemoprevention, while recently developed cyclooxygenase-2 inhibitors may be of some use in the future. Endoscopic polypectomy has been attempted for duodenal polyps and open surgical polypectomy has proven to be effective for selected patients. Photodynamic therapy and Argon plasma coagulation may be suitable to treat carpeted polyposis. New methods of duodenal resection, such as pancreas-preserving duodenectomy and pyloruspreserving pancreaticoduodenectomy, might be considered for severe duodenal polyposis; however, because prophylactic duodenal surgery has been considered too aggressive, surveillance duodenoscopy is usually performed to detect duodenal cancer at an early stage.

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References

  1. Bussey HJR (1975) Familial polyposis coli. Johns Hopkins Baltimore

    Google Scholar 

  2. Nugent KP, Spigelman AD, Phillips RKS (1993) Life expectancy after colectomy and ileorectal anastomosis for familial adenomatous polyposis. Dis Colon Rectum 36:1059–1062

    Article  PubMed  CAS  Google Scholar 

  3. Jagelman DG, DeCosse JJ, Bussey HJR (1988) Upper gastrointestinal cancer in familial adenomatous polyposis. Lancet i:1149–1151

    Article  Google Scholar 

  4. Iwama T, Mishima Y, Utsunomiya J (1993) The impact of familial adenomatous polyposis on the tumorigenesis and mortality at several organs. Its rational treatment. Ann Surg 217:101–108

    Article  PubMed  CAS  Google Scholar 

  5. Spigelman AD, Talbot IC, Penna C, Nugent KP, Phillips RKS, Costello C, DeCosse JJ (1994) Evidence for adenoma-carcinoma sequence in the duodenum of patients with familial adenomatous polyposis. J Clin Pathol 47:709–710

    Article  PubMed  CAS  Google Scholar 

  6. Hauser G (1895) Uber polyposis intestinalis adenomatosa and deren Beziehungen zur Krebsentwicklung. Deutsche Arch Klim Med 55:429–438

    Google Scholar 

  7. Funkenstein O (1904) Uber polyposis intestinalis. Z Klin Med Berl 55:236–248

    Google Scholar 

  8. Cabot RC (1935) Case records of the Massachusetts General Hospital: case no. 21061. N Engl J Med 212:263–267

    Article  Google Scholar 

  9. Murphy ES, Mireles M, Beltran A (1962) Familial polyposis of the colon and gastric carcinoma: concurrent conditions in a 16 year old boy. J Am Med Assoc 179:1026–1028

    CAS  Google Scholar 

  10. Utsunomiya J, Maki T, Iwama T, Matsunaga Y, Ichkawa T, Shimomura T, Hamaguchi E, Aoki N (1974) Gastric lesion of familial polyposis coli. Cancer 34:745–754

    Article  PubMed  CAS  Google Scholar 

  11. Yao T, Iida M, Ohsato K, Watanabe H, Omae T (1977) Duodenal lesions in familial polyposis of the colon. Gastroenterology 73:1086–1092

    PubMed  CAS  Google Scholar 

  12. Spigelman AD, Williams CB, Talbot IC, Domizio P, Phillips RKS (1989) Upper gastrointestinal cancer in patients with familial adenomatous polyposis. Lancet ii:783–785

    Article  Google Scholar 

  13. Lillemoe K, Imbembo A (1980) Malignant neoplasms of the duodenum. Surg Gynecol Obstet 150:822–826

    PubMed  CAS  Google Scholar 

  14. Jones TR, Nance FC (1977) Periampullary malignancy in Gardner’s syndrome. Ann Surg 185:565–573

    Article  PubMed  CAS  Google Scholar 

  15. Iida M, Yao T, Itoh H, Watanabe H, Matsui T, Iwashita A, Fujishima M (1989) Natural history of duodenal lesions in Japanese patients with familial adenomatosis coli (Gardner’s syndrome). Gastroenterology 96:1301–1306

    PubMed  CAS  Google Scholar 

  16. Bulow S, Alm T, Fausa O, Hultcrantz R, Jarvinen H, Vasen H, DAF Project Group (1995) Duodenal adenomatosis in familial adenomatous polyposis. DAF Project Group. Int J Colorectal Dis 10:43–46

    Article  PubMed  CAS  Google Scholar 

  17. Offerhaus GJA, Giardiello FM, Krush AJ, Booker SV, Tersmette AC, Kelly NC, Hamilton SR (1992) The risk of upper gastrointestinal cancer in familial adenomatous polyposis. Gastroenterology 102:1980–1982

    PubMed  CAS  Google Scholar 

  18. Tonelli F, Nardi F, Bechi P, Taddei G, Gozzo P, Romagnoli P (1985) Extracolonic polyps in familial polyposis coli and Gardner’s syndrome. Dis Colon Rectum 28:664–668

    Article  PubMed  CAS  Google Scholar 

  19. Bulow S, Lauritsen KB, Johansen A, Svendsen LB, Sondergaard JO (1985) Gastroduodenal polyps in familial polyposis coli. Dis Colon Rectum 28:90–93

    Article  PubMed  CAS  Google Scholar 

  20. Kurtz R, Sternberg SS, Miller HH, Decosse JJ (1987) Upper gastrointestinal neoplasia in familial polyposis. Dig Dis Sci 32:459–465

    Article  CAS  Google Scholar 

  21. Burt RW, Berenson MM, Lee RG, Tolman KG, Freston JW, Gardner EJ (1984) Upper gastrointestinal polyps in Gardner’s syndrome. Gastroenterology 86:295–301

    PubMed  CAS  Google Scholar 

  22. 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 34:167–170

    Article  PubMed  CAS  Google Scholar 

  23. 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 28:306–314

    Article  PubMed  CAS  Google Scholar 

  24. Ranzi T, Castagnone D, Velio P, Bianchi P, Polli EE (1981) Gastric and duodenal polyps in familial polyposis coli. Gut 22:363–367

    Article  PubMed  CAS  Google Scholar 

  25. Jarvinen H, Nyberg M, Peltokallio P (1983) Upper gastrointestinal tract polyps in familial adenomatosis coli. Gut 24:333–339

    Article  PubMed  CAS  Google Scholar 

  26. Sawada T, Muto T (1995) Familial adenomatous polyposis: should patients undergo surveillance of the upper gastrointestinal tract? Endoscopy 27:6–11

    Article  PubMed  CAS  Google Scholar 

  27. Marcello PW, Asbun HJ, Veidenheimer MC, Rossi RL, Robert PL, Fine SN, Coller JA, Murry JJ, Schoetz DJ (1996) Gastroduodenal polyps in familial adenomatous polyposis. Surg Endosc 10:418–424

    Article  PubMed  CAS  Google Scholar 

  28. Iida M, Aoyagi K, Fujishima Y, Matsumoto T, Hizawa K, Nakamura S (1996) Nonpolypoid adenomas of the duodenum in patients with familial adenomatous polyposis (Gardner’s syndrome). Gastrointest Endosc 44:305–308

    Article  PubMed  CAS  Google Scholar 

  29. Bertoni G, Sassatelli R, Nigrisoli E, Pennazio M, Tansini P, Arrigoni A, Ponz de Leon M, Rossini FP, Bedogni G (1996) High prevalence of adenomas and microadenomas of the duodenal papilla and periampullary region in patients with familial adenomatous polyposis. Eur J Gastroenterol Hepatol 8:1201–1206

    Article  PubMed  CAS  Google Scholar 

  30. Domizio P, Talbot IC, Spigelman AD, Williams CB, Phillips RKS (1990) Upper gastrointestinal pathology in familial adenomatous polyposis: results from a prospective study of 102 patients. J Clin Pathol 43:738–743

    Article  PubMed  CAS  Google Scholar 

  31. Spigelman AD, Phillips RKS (1994) The upper gastrointestinal tract. In: Phillips RKS, Spigelman AD, Thomson JPS (eds) Familial adenomatous polyposis and other polyposis syndromes. Edward Arnold, London, pp 106–127

    Google Scholar 

  32. Park JG, Park KJ, Ahn YO, Song IS, Choi KW, Moon HY, Choo SY, Kim JP (1992) Risk of gastric cancer among Korean familial adenomatous polyposis patients: report of three cases. Dis Colon Rectum 35:996–998

    Article  PubMed  CAS  Google Scholar 

  33. Talbot IC (1994) Pathology. In: Phillips RKS, Spigelman AD, Thomson JPS (eds) Familial adenomatous polyposis and other polyposis syndromes. Edward Arnold, London, pp 15–25

    Google Scholar 

  34. Debinski HS, Spigelman AD, Hatfield A, Williams CB, Phillips RKS (1995) Upper intestinal surveillance in familial adenomatous polyposis. Eur J Cancer 31a:1149–1153

    Article  PubMed  CAS  Google Scholar 

  35. Zwick A, Munir M, Ryan CK, Gian J, Burt RW, Leppert M, Spirio L, Chey WY (1997) Gastric adenocarcinoma and dysplasia in fundic gland polyps of a patients with attenuated adenomatous polyposis coli. Gastroenterology 113:659–663

    Article  PubMed  CAS  Google Scholar 

  36. Iida M, Yao T, Itoh H, Watanabe H, Matsui T, Iwashita A, Fujishima M (1988) Natural history of gastric adenomas in patients with familial adnomatosis coli/Gardner’s syndrome. Cancer 61:605–611

    Article  PubMed  CAS  Google Scholar 

  37. Spigelman AD, Scates DK, Venitt S, Phillips RKS (1991) DNA adducts, detected by32P-postlabelling, in the foregut of patients with familial adenomatous polyposis and in unaffected controls. Carcinogenesis 12:1727–1732

    Article  PubMed  CAS  Google Scholar 

  38. Scates DK, Spigelman AD, Phillips RKS, Venitt S (1992) DNA adducts detected by32P-postlabelling, in the intestine of rats given bile from patients with familial adenomatous polyposis and from unaffected controls. Carcinogenesis 13:731–735

    Article  PubMed  CAS  Google Scholar 

  39. Iida M, Yao T, Itoh H, Watanabe H, Kohrogi N, Shigematsu A, Iwashita A, Fujishima M (1985) Natural history of fundic gland polyposis in patients with familial adenomatosis coli/Gardner’s syndrome Gastroenterology 89:1021–1025

    PubMed  CAS  Google Scholar 

  40. Nugent KP, Spigelman AD, Williams CB, Talbot IC, Phillips RKS (1994) Surveillance of duodenal polyps in familial adenomatous polyposis: progress report. J R Soc Med 87:704–706

    PubMed  CAS  Google Scholar 

  41. Kashiwagi H, Spigelman AD, Debinski HS, Talbot IC, Phillips RKS (1994) Surveillance of ampullary adenomas in familial adenomatous polyposis. Lancet 344:1582

    Article  PubMed  CAS  Google Scholar 

  42. Noda Y, Watanabe H, Iida M, Narisawa R, Kurosaki I, Iwafuchi M, Satoh M, Ajioka Y (1992) Histologic follow-up of ampullary adenomas in patients with familial adenomatosis coli. Cancer 70:1847–1856

    Article  PubMed  CAS  Google Scholar 

  43. Nakatsubo N, Kashiwagi H, Okumura M, Kamoshida T, Takahashi A, Spigelman AD (1998) Malignant change in a duodenal adenoma in familial adenomatous polyposis. Report of a case. Am J Gastroenterol 96:1566–1568

    Google Scholar 

  44. Miyaki M, Seki M, Okamoto M, Yamanaka A, Maeda Y, Tanaka K, Kikuchi R, Iwama T, Ikeuchi T, Tonomura A, Nakamura Y, White R, Miki Y, Utsunomiya J, Mori T (1990) Genetic changes and histopathological types in colorectal tumors from patients with familial adenomatous polyposis. Cancer Res 50:7166–7173

    PubMed  CAS  Google Scholar 

  45. Miyaki M, Konishi M, Kikuchi-Yanoshita R, Enomoto M, Igari T, Tanaka K, Muraoka M, Takahashi H, Amada Y, Fukayama M, Maeda Y, Iwama T, Mishima Y, Mori T, Koike M (1994) Characteristics of somatic mutation of the adenomatous polyposis coli gene in colorectal tumors. Cancer Res 54:3011–3020

    PubMed  CAS  Google Scholar 

  46. Ando M, Takemura K, Maruyama M, Endo M, Iwama T, Yuasa Y (1992) Mutations in c-K-ras 2 gene codon 12 during colorectal tumorigenesis in familial adenomatous polyposis. Gastroenterology 103:1725–1731

    PubMed  CAS  Google Scholar 

  47. Kikuchi-Yanoshita R, Konoshi M, Ito S, Seki M, Tanaka K, Maeda Y, Iino H, Fukayama M, Koike M, Mori T, Sakuraba H, Fukunari H, Iwama T, Miyaki M (1992) Genetic changes of both p53 alleles associated with the conversion from colorectal adenoma to early carcinoma in familial adenomatous polyposis and non-familial adenomatous polyposis patients. Cancer Res 52:3965–3971

    PubMed  CAS  Google Scholar 

  48. Shirasawa S, Urabe K, Yanagawa Y, Toshitani K, Iwama T, Sasazuki T (1991) P53 gene mutations in colorectal tumors from patients with familial polyposis coli. Cancer Res 51:2874–2878

    PubMed  CAS  Google Scholar 

  49. Toyooka M, Konishi M, Kikuchi-Yanoshita R, Iwama T, Miyaki M (1995) Somatic mutations of the adenomatous polyposis coli gene in gastroduodenal tumor from patients with familial adenomatous polyposis. Cancer Res 55:3165–3170

    PubMed  CAS  Google Scholar 

  50. Gallinger S, Vivona AA, Odze RD, Mitri A, O’Beirne CP, Berk TC, Bapat BV (1995) Somatic APC and K-ras codon 12 mutations in periampullary adenomas and carcinomas from familial adenomatous polyposis patients. Oncogene 10:1875–1878

    PubMed  CAS  Google Scholar 

  51. Kashiwagi H, Spigelman AD, Talbot IC, Phillips RKS (1996) P53 overexpression in duodenal tumours in patients with familial adenomatous polyposis. Br J Surg 83:225–228

    Article  PubMed  CAS  Google Scholar 

  52. Kashiwagi H, Spigelman AD, Talbot IC, Debinski HS, McKie AB, Lemoine NR, Phillips RKS (1997) P53 and K-ras status in duodenal adenomas in familial adenomatous polyposis. Br J Surg 84:856–859

    Article  Google Scholar 

  53. Sanabria JR, Croxford R, Berk TC, Cohen Z, Bapat BV, Gallinger S (1996) Familial segregation in the occurrence and severity of periampullary neoplasms in familial adenomatous polyposis. Am J Surg 171:136–141

    Article  PubMed  CAS  Google Scholar 

  54. Soravia C, Berk T, Madlensky L, Mitri A, Cheng H, Gallinger S, Cohen Z, Bapat B (1998) Genotype-phenotype correlations in attenuated adenomatous polyposis coli. Am J Hum Genet 62:1290–1301

    Article  PubMed  CAS  Google Scholar 

  55. Lynch HT, Smyrk T, McGinn T, Lanspa S, Cavalieri J, Lynch J, Slominski-Castor S, Cayouette MC, Priluck I, Luce MC (1995) Attenuated familial adenomatous polyposis (AFAP): a phenotypically and genotypically distinctive variant of FAP. Cancer 76:2427–2433

    Article  PubMed  CAS  Google Scholar 

  56. Leggett BA, Young JP, Biden K, Buttenshaw RL, Knight N, Cowen AE (1997) Severe upper gastrointestinal polyposis associated with sparse colonic polyposis in a familial adenomatous polyposis family with an APC mutation at codon 1520. Gut 41:518–521

    Article  PubMed  CAS  Google Scholar 

  57. Dobbie Z, Heinimann K, Bishop D, Muller H, Scott R (1997) Identification of a modifier gene locus on chromosome 1p35-36 in familial adenomatous polyposis. Hum Genet 99:653–657

    Article  PubMed  CAS  Google Scholar 

  58. Tomlinson IPM, Neal K, Talbot IC, Spigelman AD, Williams CB, Phillips RKS, Bodmer WF (1996) A modifying locus for familial adenomatous polyposis may be present on chromosome 1p35-p36. J Med Genet 33:268–273

    Article  PubMed  CAS  Google Scholar 

  59. Spigelman AD, Farmer KCR, Oliver S, Nugent KP, Bennett PN, Notarianni LJ, Dobrocky P, Phillips RKS (1995) Caffeine phenotyping of cytochrome P4501A2, N-acetyltransferase, and xanthine oxidase in patients with familial adenomatous polyposis. Gut 36:251–254

    Article  PubMed  CAS  Google Scholar 

  60. Nugent KP, Northover J (1994) Total colectomy and ileorectal anastomosis. In: Phillips RKS, Spigelman AD, Thomson JPS (eds) Familial adenomatous polyposis and other polyposis syndromes. Edward Arnold, London, pp 79–91

    Google Scholar 

  61. Bleau BL, Gostout CJ (1996) Endoscopic treatment of ampullary adnomas in familial adenomatous polyposis. J Clin Gastroenterol 22:237–241

    Article  PubMed  CAS  Google Scholar 

  62. Binmoeller KF, Boaventura S, Ramsperger K, Soehendra N (1993) Endoscopic snare excision of benign adenomas of the papilla of Vater. Gastrointest Endosc 39:127–131

    Article  PubMed  CAS  Google Scholar 

  63. Iwama T, Tomita H, Kawachi Y, Yoshinaga K, Kume S, Maruyama H, Mishima Y (1994) Indications for local excision of ampullary lesions associated with familial adenomatous polyposis. J Am Coll Surg 179:462–464

    PubMed  CAS  Google Scholar 

  64. Penna C, Phillips RK, Tiret E, Spigelman AD (1993) Surgical polypectomy of duodenal adenomas in familal adenomatous polyposis; experience of two European centers. Br J Surg 80:1027–1029

    Article  PubMed  CAS  Google Scholar 

  65. Midwinter MJ, Beveridge CJ, Wilsdon JB, Bennett MK, Baudouin CJ, Charnley RM (1999) Correlation between spiral computed tomography, endoscopic ultrasonography and findings at operation in pancreatic and ampullary tumours. Br J Surg 86:189–193

    Article  PubMed  CAS  Google Scholar 

  66. Chung RS, Church JM, van Stock R (1995) Pancreas-sparing duodenectomy; indications, surgical technique, and results. Surgery 117:254–259

    Article  PubMed  CAS  Google Scholar 

  67. Penna C, Bataille N, Balladur P, Tiret E, Parc R (1998) Surgical treatment of severe duodenal polyposis in familial adenomatous polyposis. Br J Surg 85:665–668

    Article  PubMed  CAS  Google Scholar 

  68. Mlkvy P, Messman H, Debinski H, Regula J, Conio M, MacRobert A, Spigelman AD, Phillips RKS, Bown SG (1995) Photodynamic therapy for polyps in familial adenomatous polyposis — a pilot study. Eur J Cancer 31a:1160–1165

    PubMed  CAS  Google Scholar 

  69. Nugent KP, Farmer KCR, Spigelman AD, Williams CB, Phillips RKS (1993) Randomized controlled trial of the effect of sulindac on duodenal and rectal polyposis and cell proliferation in patients with familial adenomatous polyposis. Br J Surg 80:1618–1619

    Article  PubMed  CAS  Google Scholar 

  70. Smith WL (1993) Prostanoid biosynthesis and mechanism of action. Am J Physiol 263:F181-F191

    Google Scholar 

  71. Oshima M, Dinchuk JE, Kargman SL, Oshima H, Hancock B, Kwong E, Traskos JM, Evans JF, Taketo MM (1996) Suppression of intestinal polyposis inApc 716 knockout mice by inhibition of cyclooxygenase 2 (COX-2). Cell 87:803–809

    Article  PubMed  CAS  Google Scholar 

  72. Soew-Chen F, Ho JM, 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 7:177–183

    Article  Google Scholar 

  73. Church JM, McGannon E, Hull-Boiner S, Sivak MV, van Stolk R, Jagelman DG, Fazio VW, Oakley JR, Lavery IC, Milson JW (1992) Gastroduodenal polyps in patients with familial adenomatous polyposis. Dis Colon Rectum 35:1170–1173

    Article  PubMed  CAS  Google Scholar 

  74. Goedde TA, Rodriguez-Bigas MA, Herrera L, Petrelli NJ (1992) Gastroduodenal polyps in familial adenomatous polyposis. Surg Oncol 1:357–361

    Article  PubMed  CAS  Google Scholar 

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  1. Department of Surgery, Jichi Medical School, 3311-1 Yakushiji, Minami-kawachi, 329-04, Tochigi, Japan

    Hiroshi Kashiwagi

  2. Discipline of Surgical Science, Faculty of Medicine and Health Sciences, The University of Newcastle, Newcastle, NSW, Australia

    Allan D. Spigelman

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  1. Hiroshi Kashiwagi
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Kashiwagi, H., Spigelman, A.D. Gastroduodenal lesions in familial adenomatous polyposis. Surg Today 30, 675–682 (2000). https://doi.org/10.1007/s005950070077

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