Skip to main content

Advertisement

SpringerLink
Log in

The prevalence of small intestinal polyps in patients with familial adenomatous polyposis: a prospective capsule endoscopy study

  • Original Article
  • Published:
Familial Cancer Aims and scope Submit manuscript

Abstract

Familial adenomatous polyposis (FAP) is a genetic disorder in which multiple colorectal polyps and cancers develop. However, the prevalence of small intestinal tumors in patients with FAP remains unclear. We elucidated the prevalence of polyps in the small intestine and duodenum using capsule endoscopy (CE). Patients with FAP receiving a periodic screening colonoscopy at Kyoundo Hospital were encouraged to participate in the study. All study participants underwent esophagogastroduodenoscopy (EGD) within 2 weeks before CE. Outcome measurements were the prevalence of duodenal polyps (DP) and small intestinal polyp (SIP), detectability of the ampulla of Vater, and concordance of the duodenal findings between CE and EGD. Twenty-three patients (mean age, 47 years; 15 males) were enrolled in the study. CE showed DPs in 11 patients (52 %) and SIPs in nine patients (43 %). The mean numbers of DPs and SIPs was 11.5 ± 6.2 and 11.9 ± 10.9, respectively. SIPs were more often detected in patients with DPs versus those without (62 vs. 13 %, P = 0.07). The ampulla of Vater was observed by CE in four patients (21 %). EGD showed DPs in 13 patients (62 %). EGD missed DPs in two of 11 patients with DPs detected by CE. EGD found DPs in four of 10 patients without DPs using CE. The kappa index was 0.422. Patients with FAP have a high prevalence of polyps in the small intestine. Although the clinical significance of small intestinal polyps remains unclear, patients with FAP seem to be good candidates for CE.

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

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

FAP:

Familial adenomatous polyposis

CE:

Capsule endoscopy

DP:

Duodenal polyp

SIP:

Small intestinal polyp

EGD:

Esophagogastroduodenoscopy

PE:

Push enteroscopy

BE:

Balloon enteroscopy

DBE:

Double-balloon endoscopy

References

  1. Bodmer WF, Bailey CJ, Bodmer J et al (1987) Localization of the gene for familial adenomatous polyposis on chromosome 5. Nature 328(6131):614–616. doi:10.1038/328614a0

    Article  CAS  PubMed  Google Scholar 

  2. Kinzler KW, Nilbert MC, Su LK et al (1991) Identification of FAP locus genes from chromosome 5q21. Science 253(5020):661–665

    Article  CAS  PubMed  Google Scholar 

  3. Groden J, Thliveris A, Samowitz W et al (1991) Identification and characterization of the familial adenomatous polyposis coli gene. Cell 66(3):589–600

    Article  CAS  PubMed  Google Scholar 

  4. Galiatsatos P, Foulkes WD (2006) Familial adenomatous polyposis. Am J Gastroenterol 101(2):385–398. doi:10.1111/j.1572-0241.2006.00375.x

    Article  PubMed  Google Scholar 

  5. Galle TS, Juel K, Bülow S (1999) Causes of death in familial adenomatous polyposis. Scand J Gastroenterol 34(8):808–812

    Article  CAS  PubMed  Google Scholar 

  6. Björk J, Akerbrant H, Iselius L et al (2001) Periampullary adenomas and adenocarcinomas in familial adenomatous polyposis: cumulative risks and APC gene mutations. Gastroenterology 121(5):1127–1135

    Article  PubMed  Google Scholar 

  7. Schulmann K, Hollerbach S, Kraus K et al (2005) Feasibility and diagnostic utility of video capsule endoscopy for the detection of small bowel polyps in patients with hereditary polyposis syndromes. Am J Gastroenterol 100(1):27–37. doi:10.1111/j.1572-0241.2005.40102.x

    Article  PubMed  Google Scholar 

  8. Spigelman AD, Williams CB, Talbot IC, Domizio P, Phillips RK (1989) Upper gastrointestinal cancer in patients with familial adenomatous polyposis. Lancet 2(8666):783–785

    Article  CAS  PubMed  Google Scholar 

  9. Groves CJ, Saunders BP, Spigelman AD, Phillips RK (2002) Duodenal cancer in patients with familial adenomatous polyposis (FAP): results of a 10 year prospective study. Gut 50(5):636–641

    Article  CAS  PubMed  Google Scholar 

  10. Saurin JC, Gutknecht C, Napoleon B et al (2004) Surveillance of duodenal adenomas in familial adenomatous polyposis reveals high cumulative risk of advanced disease. J Clin Oncol 22(3):493–498. doi:10.1200/JCO.2004.06.028

    Article  PubMed  Google Scholar 

  11. Dunlop MG, Gastroenterology BSf, Ireland AoCfGBa (2002) Guidance on gastrointestinal surveillance for hereditary non-polyposis colorectal cancer, familial adenomatous polypolis, juvenile polyposis, and Peutz–Jeghers syndrome. Gut 51(Suppl 5):V21–V27

    Article  PubMed  Google Scholar 

  12. Burt RW (2000) Colon cancer screening. Gastroenterology 119(3):837–853

    Article  CAS  PubMed  Google Scholar 

  13. Winawer S, Fletcher R, Rex D et al (2003) Colorectal cancer screening and surveillance: clinical guidelines and rationale—update based on new evidence. Gastroenterology 124(2):544–560. doi:10.1053/gast.2003.50044

    Article  PubMed  Google Scholar 

  14. Ell C, Remke S, May A, Helou L, Henrich R, Mayer G (2002) The first prospective controlled trial comparing wireless capsule endoscopy with push enteroscopy in chronic gastrointestinal bleeding. Endoscopy 34(9):685–689. doi:10.1055/s-2002-33446

    Article  CAS  PubMed  Google Scholar 

  15. Lewis B, Swain P (2002) Capsule endoscopy in the evaluation of patients with suspected small intestinal bleeding: results of a pilot study. Gastrointest Endosc 56(3):349–353

    Article  PubMed  Google Scholar 

  16. Pennazio M, Santucci R, Rondonotti E et al (2004) Outcome of patients with obscure gastrointestinal bleeding after capsule endoscopy: report of 100 consecutive cases. Gastroenterology 126(3):643–653. doi:10.1053/j.gastro.2003.11.057

    Article  PubMed  Google Scholar 

  17. Yu M (2002) M2A capsule endoscopy. A breakthrough diagnostic tool for small intestine imaging. Gastroenterol Nurs 25(1):24–27

    Article  PubMed  Google Scholar 

  18. Ge ZZ, Chen HY, Gao YJ, Hu YB, Xiao SD (2006) The role of simeticone in small-bowel preparation for capsule endoscopy. Endoscopy 38(8):836–840

    Article  PubMed  Google Scholar 

  19. Albert J, Gobel CM, Lesske J, Lotterer E, Nietsch H, Fleig WE (2004) Simethicone for small bowel preparation for capsule endoscopy: a systematic, single-blinded, controlled study. Gastrointest Endosc 59(4):487–491

    Article  PubMed  Google Scholar 

  20. Caspari R, von Falkenhausen M, Krautmacher C, Schild H, Heller J, Sauerbruch T (2004) Comparison of capsule endoscopy and magnetic resonance imaging for the detection of polyps of the small intestine in patients with familial adenomatous polyposis or with Peutz–Jeghers’ syndrome. Endoscopy 36(12):1054–1059. doi:10.1055/s-2004-826041

    Article  CAS  PubMed  Google Scholar 

  21. Iaquinto G, Fornasarig M, Quaia M et al (2008) Capsule endoscopy is useful and safe for small-bowel surveillance in familial adenomatous polyposis. Gastrointest Endosc 67(1):61–67. doi:10.1016/j.gie.2007.07.048

    Article  PubMed  Google Scholar 

  22. Matsumoto T, Esaki M, Yanaru-Fujisawa R et al (2008) Small-intestinal involvement in familial adenomatous polyposis: evaluation by double-balloon endoscopy and intraoperative enteroscopy. Gastrointest Endosc 68(5):911–919. doi:10.1016/j.gie.2008.02.067

    Article  PubMed  Google Scholar 

  23. Katsinelos P, Kountouras J, Chatzimavroudis G et al (2009) Wireless capsule endoscopy in detecting small-intestinal polyps in familial adenomatous polyposis. World J Gastroenterol 15(48):6075–6079. doi:10.3748/wjg.15.6075

    Article  PubMed  Google Scholar 

  24. Gunther U, Bojarski C, Buhr HJ, Zeitz M, Heller F (2010) Capsule endoscopy in small-bowel surveillance of patients with hereditary polyposis syndromes. Int J Colorectal Dis 25(11):1377–1382. doi:10.1007/s00384-010-0982-x

    Article  PubMed  Google Scholar 

  25. Burke CA, Santisi J, Church J, Levinthal G (2005) The utility of capsule endoscopy small bowel surveillance in patients with polyposis. Am J Gastroenterol 100(7):1498–1502. doi:10.1111/j.1572-0241.2005.41506.x

    Article  PubMed  Google Scholar 

  26. Pasha SF, Leighton JA, Das A et al (2008) Double-balloon enteroscopy and capsule endoscopy have comparable diagnostic yield in small-bowel disease: a meta-analysis. Clin Gastroenterol Hepatol 6(6):671–676. doi:10.1016/j.cgh.2008.01-005

    Article  PubMed  Google Scholar 

  27. Matsumoto T, Esaki M, Moriyama T, Nakamura S, Iida M (2005) Comparison of capsule endoscopy and enteroscopy with the double-balloon method in patients with obscure bleeding and polyposis. Endoscopy 37(9):827–832. doi:10.1055/s-870207

    Article  CAS  PubMed  Google Scholar 

  28. Mata A, Llach J, Castells A et al (2005) A prospective trial comparing wireless capsule endoscopy and barium contrast series for small-bowel surveillance in hereditary G1 polyposis syndromes. Gastrointest Endosc 61(6):721–725. doi:10.1016/s0016-5107(05)00289-0

    Article  PubMed  Google Scholar 

  29. Plum N, May A, Manner H, Ell C (2009) Small-bowel diagnosis in patients with familial adenomatous polyposis: comparison of push enteroscopy, capsule endoscopy, ileoscopy, and enteroclysis. Z Gastroenterol 47(4):339–346. doi:10.1055/s-2008-1027984

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Atsuo Yamada, Hirotsugu Watabe, Masao Omata & Kazuhiko Koike

  2. Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, 1397-1 Yamane Hidaka-shi, Saitama, Japan

    Takeo Iwama

  3. Department of Hepatology, Sasaki Institute, Kyoundo Hospital, 1-8 Kandasurugadai, Chiyoda-ku, Tokyo, Japan

    Shuntaro Obi

Authors
  1. Atsuo Yamada
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hirotsugu Watabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Takeo Iwama
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shuntaro Obi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Masao Omata
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kazuhiko Koike
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Atsuo Yamada.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yamada, A., Watabe, H., Iwama, T. et al. The prevalence of small intestinal polyps in patients with familial adenomatous polyposis: a prospective capsule endoscopy study. Familial Cancer 13, 23–28 (2014). https://doi.org/10.1007/s10689-013-9668-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10689-013-9668-1

Keywords

Search

Navigation