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Prevalence and Morphology of Pouch and Ileal Adenomas in Familial Adenomatous Polyposis

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Diseases of the Colon & Rectum

PURPOSE

In familial adenomatous polyposis, the long-term risk of pouch polyposis and potential for pouch cancer are unknown. Our aim was to evaluate prospectively the prevalence, nature, and etiology of pouch ileal adenomas with that of nonpouch ileal adenomas in familial adenomatous polyposis.

METHODS

Sixty patients with familial adenomatous polyposis pouch, 47 familial adenomatous polyposis patients with ileorectal anastomosis, and 20 younger patients with familial adenomatous polyposis who had prophylactic colectomy were examined with videoendoscopy.

RESULTS

Adenomatous polyps were found in the pouches of 34 patients (57 percent). A total of 362 polyps were identified (range, 0–50 per patient). A logistic regression model confirmed that there was a significant association between the increasing age of the patient and the presence of pouch adenomas (P < 0.02) and the length of follow-up since pouch surgery (P < 0.05). There was no apparent relationship between the development of pouch adenomas and the severity of either colonic or duodenal polyposis and there were no clear genotype or phenotype correlations. Most polyps were tubular adenomas with mild dysplasia, but 11 patients had more advanced histology, including two patients with large villous adenomas. Nonpouch ileal mucosa was spared from visually observed adenomas, with only 1 of 48 (2 percent) patients with ileorectal anastomosis adenomas and 0 of 20 (0 percent) younger, precolectomy patients having terminal ileal adenomas. However, microadenomas were present on random biopsy in 4 percent to 5 percent of nonpouch ileum.

CONCLUSION

The risk of pouch cancer in familial adenomatous polyposis is unclear, but follow-up periods since surgery remain relatively short. Long-term endoscopic surveillance of familial adenomatous polyposis pouches is thus recommended along with evaluation of potential therapeutic options for pouch adenomas.

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REFERENCES

  1. KP Nugent AD Spigelman RK Phillips (1993) ArticleTitleLife expectancy after colectomy and ileorectal anastomosis for familial polyposis Dis Colon Rectum 36 1059–62 Occurrence Handle1:STN:280:ByuD3sfktlU%3D Occurrence Handle8223060

    CAS  PubMed  Google Scholar 

  2. KP Nugent AD Spigelman RJ Nicholls et al. (1993) ArticleTitlePouch adenomas in patients with familial adenomatous polyposis Br J Surg 80 1620 Occurrence Handle1:STN:280:ByuC3s%2Fgs1w%3D Occurrence Handle8298944

    CAS  PubMed  Google Scholar 

  3. Y Parc S Olschwang B Desaint et al. (2001) ArticleTitleFamilial adenomatous polyposis: prevalence of adenomas in the ileal pouch after restorative proctocolectomy Ann Surg 233 360–4 Occurrence Handle10.1097/00000658-200103000-00009 Occurrence Handle1:STN:280:DC%2BD3M7ps1eltw%3D%3D Occurrence Handle11224623

    Article  CAS  PubMed  Google Scholar 

  4. MW Thompson-Fawcett VA Marcus M Redston et al. (2001) ArticleTitleAdenomatous polyps develop commonly in the ileal pouch of patients with familial adenomatous polyposis Dis Colon Rectum 44 347–53 Occurrence Handle1:STN:280:DC%2BD3M7pvFykuw%3D%3D Occurrence Handle11289279

    CAS  PubMed  Google Scholar 

  5. JS Wu EA McGannon JM Church (1998) ArticleTitleIncidence of neoplastic polyps in the ileal pouch of patients with familial adenomatous polyposis after restorative proctocolectomy Dis Colon Rectum 41 552–6 Occurrence Handle1:STN:280:DyaK1c3lsVSltQ%3D%3D Occurrence Handle9593235

    CAS  PubMed  Google Scholar 

  6. M Iida H Itoh T Matsui et al. (1989) ArticleTitleIleal adenomas in postcolectomy patients with familial adenomatosis coli/Gardner’s syndrome. Incidence and endoscopic appearance Dis Colon Rectum 32 1034–8 Occurrence Handle1:STN:280:By%2BD2srptVM%3D Occurrence Handle2556253

    CAS  PubMed  Google Scholar 

  7. F Tonelli F Nardi P Bechi et al. (1985) ArticleTitleExtracolonic polyps in familial polyposis coli and Gardner’s syndrome Dis Colon Rectum 28 664–8 Occurrence Handle1:STN:280:BimD38botVE%3D Occurrence Handle4053908

    CAS  PubMed  Google Scholar 

  8. T Matsumoto M Iida M Mizuno et al. (1999) ArticleTitleIn vivo observation of the ileal microadenoma in familial adenomatous polyposis Am J Gastroenterol 94 3354–8 Occurrence Handle10.1111/j.1572-0241.1999.01552.x Occurrence Handle1:STN:280:DC%2BD3c%2FjtFSiuw%3D%3D Occurrence Handle10566743

    Article  CAS  PubMed  Google Scholar 

  9. CR Uff RK Phillips (1993) ArticleTitleEffect of suture material on tumor cell adherence at sites of colonic injury [letter] Br J Surg 80 1354 Occurrence Handle1:STN:280:ByuD287kvVM%3D

    CAS  Google Scholar 

  10. JC Hoehner AM Metcalf (1994) ArticleTitleDevelopment of invasive adenocarcinoma following colectomy with ileoanal anastomosis for familial polyposis coli: report of a case Dis Colon Rectum 37 824–8 Occurrence Handle1:STN:280:ByuA3szgvVE%3D Occurrence Handle8055729

    CAS  PubMed  Google Scholar 

  11. A Von Herbay J Stern C Herfarth (1996) ArticleTitlePouch-anal cancer after restorative proctocolectomy for familial adenomatous polyposis Am J Surg Pathol 20 995–9 Occurrence Handle10.1097/00000478-199608000-00008 Occurrence Handle8712299

    Article  PubMed  Google Scholar 

  12. H Vuilleumier N Halkic R Ksontini et al. (2000) ArticleTitleColumnar cuff cancer after restorative proctocolectomy for familial adenomatous polyposis Gut 47 732–4 Occurrence Handle10.1136/gut.47.5.732 Occurrence Handle1:STN:280:DC%2BD3M%2FjvVSmtg%3D%3D Occurrence Handle11034594

    Article  CAS  PubMed  Google Scholar 

  13. D Puthu N Rajan R Rao et al. (1992) ArticleTitleCarcinoma of the rectal pouch following restorative proctocolectomy: report of a case Dis Colon Rectum 35 257–60 Occurrence Handle1:STN:280:By2C2MrgtVY%3D Occurrence Handle1740073

    CAS  PubMed  Google Scholar 

  14. MM Bassuini PJ Billings (1996) ArticleTitleCarcinoma in an ileoanal pouch after restorative proctocolectomy for familial adenomatous polyposis Br J Surg 83 506 Occurrence Handle1:STN:280:BymB28zhsVU%3D Occurrence Handle8665242

    CAS  PubMed  Google Scholar 

  15. T Muto HJ Bussey BC Morson (1975) ArticleTitleThe evolution of cancer of the colon and rectum Cancer 36 2251–70 Occurrence Handle1:STN:280:CSmD1M%2FhvFA%3D Occurrence Handle1203876

    CAS  PubMed  Google Scholar 

  16. KP Nugent RK Phillips SV Hodgson et al. (1994) ArticleTitlePhenotypic expression in familial adenomatous polyposis: partial prediction by mutation analysis Gut 35 1622–3 Occurrence Handle1:STN:280:ByqC38bpslY%3D Occurrence Handle7828985

    CAS  PubMed  Google Scholar 

  17. R Caspari W Friedl M Mandl et al. (1994) ArticleTitleFamilial adenomatous polyposis: mutation at codon 1309 and early onset of colon cancer Lancet 343 629–32 Occurrence Handle10.1016/S0140-6736(94)92634-4 Occurrence Handle1:STN:280:ByuC2MfltF0%3D Occurrence Handle7906810

    Article  CAS  PubMed  Google Scholar 

  18. RJ Nicholls AK Banerjee (1998) ArticleTitlePouchitis: risk factors, etiology, and treatment World J Surg 22 347–51 Occurrence Handle10.1007/s002689900395 Occurrence Handle1:STN:280:DyaK1c7osVWitA%3D%3D Occurrence Handle9523515

    Article  CAS  PubMed  Google Scholar 

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ACKNOWLEDGMENTS

The authors thank Kay Neale and all at the St. Mark’s Hospital Polyposis Registry; the staff of the Wolfson Unit for Endoscopy, St. Mark’s Hospital; and Pauline Rogers and Chris Cardwell for statistical help.

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Authors and Affiliations

  1. The Polyposis Registry, Cancer Research UK Colorectal Cancer Unit, St. Mark’s Hospital, Harrow, United Kingdom

    Christopher J. Groves M.R.C.P., Iain G. Beveridge M.R.C.P., David J. Swain R.N. Dip. HE, Brian P. Saunders M.D., Ian C. Talbot M.S., R. John Nicholls M.A. & Robin K. Phillips M.S.

Authors
  1. Christopher J. Groves M.R.C.P.
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  2. Iain G. Beveridge M.R.C.P.
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  3. David J. Swain R.N. Dip. HE
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  4. Brian P. Saunders M.D.
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  5. Ian C. Talbot M.S.
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  6. R. John Nicholls M.A.
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  7. Robin K. Phillips M.S.
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Corresponding author

Correspondence to Robin K. Phillips M.S..

Additional information

I. G. Beveridge and C. J. Groves were supported by Cancer Research UK (formerly the Imperial Cancer Research Fund).

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Groves, C., Beveridge, I., Swain, D. et al. Prevalence and Morphology of Pouch and Ileal Adenomas in Familial Adenomatous Polyposis. Dis Colon Rectum 48, 816–823 (2005). https://doi.org/10.1007/s10350-004-0835-1

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  • DOI: https://doi.org/10.1007/s10350-004-0835-1

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