Impact of Endoscopic Duodenal and Ampullary Resection in Fap Patients: Spigelman Classification can be Considered as Outdated Even in Stage III and IV

Aims In familial adenomatous polyposis (FAP) a dedicated endoscopic surveillance with endoscopic resection (ER) of duodenal and ampullary lesions has been proposed by the European guidelines. The Spigelman classification (SC) is used to define surgical indications in patients with advanced duodenal disease. Aims: describe the impact of ER in patients with FAP and the role played by SC.

Methods This is a national-based observational retrospective study based on a prospective national registry (FAPA 1998-2020). All consecutive >18 years-old patients with genetically confirmed FAP who underwent endoscopic follow-up for duodenal lesions were included. ER was performed according to the characteristics of the lesions (CSP, EMR, ESD, ampullectomy). The demographic, clinical and endoscopic data, SC, presence of an ampullary tumor, and most advanced pathology were noted. The main outcome was to describe the impact of ER by analyzing the occurrence of advanced lesions, and need for surgery.

Results One-hundred and eleven patients (25 ± 14 years, 49.5 % male) were included with a median f-up of 168 m (range: 6-408) and 10 endoscopies (2-35). The baseline Spigelman stage (median: 1, range:0-4) was classified as 0 (38.9 %), I (5.3 %), II (13.7 %), III (20 %) and IV (22.1 %) at the beginning of follow-up before endotherapy, and decreased by 1 point at latest endoscopy, with a statistically significant decrease in advanced SC (42.1 %% vs. 25.3 %, p<0.001). Only one case showed an invasive duodenal adenocarcinoma on f-up (1.1 %) with a 0-stage in baseline SC. SC was not associated to an increased incidence of cancer (p=0.238) or need for surgery (p=0.662).

Conclusions Duodenal endotherapy in FAP patients is effective, with a rare incidence of invasive carcinoma or need for surgery. Patients with a high number of NADTs can be safely treated by endoscopy. Spigelman classification seems outdated since not related to invasive cancer or need for surgery, in patients with regular f-up and ER.

Citation: Belhassine M, Pérez-Cuadrado Robles E, Dahan K et al. eP157 IMPACT OF ENDOSCOPIC DUODENAL AND AMPULLARY RESECTION IN FAP PATIENTS: SPIGELMAN CLASSIFICATION CAN BE CONSIDERED AS OUTDATED EVEN IN STAGE III AND IV. Endoscopy 2021; 53: S147.

Publication History

Article published online:
19 March 2021