CC BY-NC-ND 4.0 · Endoscopy 2023; 55(04): 344-352
DOI: 10.1055/a-1945-9120
Original article

Intensive endoscopic resection for downstaging of polyp burden in patients with familial adenomatous polyposis (J-FAPP Study III): a multicenter prospective interventional study

Hideki Ishikawa
1   Department of Molecular-Targeting Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan
2   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
Yasushi Sato
3   Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine, Hokkaido, Japan
4   Endoscopy and Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
Chino Akiko
5   Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
6   Department of Endoscopy, Aichi Cancer Center Hospital, Aichi, Japan
Hisashi Doyama
7   Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan
Tetsuji Takayama
8   Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
Yoshio Ohda
9   Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
Takahiro Horimatsu
10   Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
11   Sano Hospital, Hyogo, Japan
Kohji Tanakaya
12   Department of Surgery, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Japan
Hiroaki Ikematsu
13   Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
Yoshihisa Saida
14   Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
Hideyuki Ishida
15   Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
16   Department of Gastrointestinal Oncology, Osaka International Cancer Institute (formerly Osaka Medical Center for Cancer and Cardiovascular Diseases), Osaka, Japan
Hiroshi Kashida
17   Department of Gastroenterology and Hepatology, Kindai University, Osaka, Japan
Shinsuke Kiriyama
18   Department of Surgery, Gunma Chuo Hospital, Gunma, Japan
Shinichiro Hori
19   Department of Internal Medicine, National Hospital Organization Shikoku Cancer Center, Ehime, Japan
Kyowon Lee
20   Moriguchi Keijinkai Hospital, Osaka, Japan
Jun Tashiro
21   Department of Gastroenterology, Toshiba Hospital, Tokyo, Japan
Nozomu Kobayashi
22   Department of Gastroenterology, Tochigi Cancer Center, Tochigi, Japan
Takeshi Nakajima
2   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
Sadao Suzuki
23   Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
Michihiro Mutoh
1   Department of Molecular-Targeting Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan
24   Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening/Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
J-FAPP Study III Group › Author Affiliations
Trial Registration: Registration number (trial ID): NCT03567863 Type of study: Multicenter randomized crossover trial


Background Total colectomy is the standard treatment for familial adenomatous polyposis (FAP). Recently, an increasing number of young patients with FAP have requested the postponement of surgery or have refused to undergo surgery. We aimed to evaluate the effectiveness of intensive endoscopic removal for downstaging of polyp burden (IDP) in FAP.

Method A single-arm intervention study was conducted at 22 facilities. Participants were patients with FAP, aged ≥ 16 years, who had not undergone colectomy or who had undergone colectomy but had ≥ 10 cm of large intestine remaining. For IDP, colorectal polyps of ≥ 10 mm were removed, followed by polyps of ≥ 5 mm. The primary end point was the presence/absence of colectomy during a 5-year intervention period.

Results 222 patients were eligible, of whom 166 had not undergone colectomy, 46 had undergone subtotal colectomy with ileorectal anastomosis, and 10 had undergone partial resection of the large intestine. During the intervention period, five patients (2.3 %, 95 % confidence interval [CI] 0.74 %–5.18 %) underwent colectomy, and three patients died. Completion of the 5-year intervention period without colectomy was confirmed in 150 /166 patients who had not undergone colectomy (90.4 %, 95 %CI 84.8 %–94.4 %) and in 47 /56 patients who had previously undergone colectomy (83.9 %, 95 %CI 71.7 %–92.4 %).

Conclusion IDP in patients with mild-to-moderate FAP could have the potential to be a useful means of preventing colorectal cancer without implementing colectomy. However, if the IDP protocol was proposed during a much longer term, it may not preclude the possibility that a large proportion of colectomies may still need to be performed.

Supplementary material

Publication History

Received: 24 April 2022

Accepted after revision: 24 August 2022

Article published online:
10 October 2022

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