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CC BY-NC-ND 4.0 · Endoscopy 2021; 53(08): 795-801
DOI: 10.1055/a-1265-2716
Original article

Gastric adenomas and their management in familial adenomatous polyposis

Isabel Martin
1   The Polyposis Registry, St. Mark’s Hospital, London, United Kingdom
2   Department of Surgery and Cancer, Imperial College London, United Kingdom
,
Victorine H. Roos
3   Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Netherlands
,
Chukwuemeka Anele
1   The Polyposis Registry, St. Mark’s Hospital, London, United Kingdom
2   Department of Surgery and Cancer, Imperial College London, United Kingdom
,
Sarah-Jane Walton
4   Department of Surgery, Basildon and Thurrock University Hospital, Basildon, United Kingdom
,
Victoria Cuthill
1   The Polyposis Registry, St. Mark’s Hospital, London, United Kingdom
,
Noriko Suzuki
1   The Polyposis Registry, St. Mark’s Hospital, London, United Kingdom
,
Barbara A. Bastiaansen
3   Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Netherlands
,
Susan K. Clark
1   The Polyposis Registry, St. Mark’s Hospital, London, United Kingdom
2   Department of Surgery and Cancer, Imperial College London, United Kingdom
,
Alexander von Roon
5   Department of Surgery, University College Hospital, London, United Kingdom
,
Evelien Dekker
3   Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Netherlands
,
Andrew Latchford
1   The Polyposis Registry, St. Mark’s Hospital, London, United Kingdom
2   Department of Surgery and Cancer, Imperial College London, United Kingdom
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Author commentary on Isabel Martin et al.Endoscopy 2021; 53(08): v39-v39
DOI: 10.1055/a-1326-4948

Abstract

Background Patients with familial adenomatous polyposis (FAP) are at increased risk of developing gastric adenomas. There is limited understanding of their clinical course and no consensus on management. We reviewed the management of gastric adenomas in patients with FAP from two centers.

Methods Patients with FAP and histologically confirmed gastric adenomas were identified between 1997 and 2018. Patient demographics, adenoma characteristics, and management/surveillance outcomes were collected.

Results Of 726 patients with FAP, 104 (14 %; 49 female) were diagnosed with gastric adenomas at a median age of 47 years (range 19 – 80). The median size of gastric adenomas was 6 mm (range 1.5 – 50); 64 (62 %) patients had adenomas located distally to the incisura. Five patients (5 %) had gastric adenomas demonstrating high-grade dysplasia (HGD) on initial diagnosis, distributed equally within the stomach. The risk of HGD was associated with adenoma size (P = 0.04). Of adenomas > 20 mm, 33 % contained HGD. Two patients had gastric cancer at initial gastric adenoma diagnosis. A total of 63 patients (61 %) underwent endoscopic therapy for gastric adenomas. Complications occurred in three patients (5 %) and two (3 %) had recurrence, all following piecemeal resection of large (30 – 50 mm) lesions. Three patients were diagnosed with gastric cancer at median follow-up of 66 months (range 66 – 115) after initial diagnosis.

Conclusions We observed gastric adenomas in 14 % of patients with FAP. Of these, 5 % contained HGD; risk of HGD correlated with adenoma size. Endoscopic resection was feasible, with few complications and low recurrence rates, but did not completely eliminate the cancer risk.

Supplementary material



Publication History

Received: 21 February 2020

Accepted: 17 September 2020

Accepted Manuscript online:
17 September 2020

Article published online:
05 November 2020

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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