Endoscopy 2009; 41(6): 504-509
DOI: 10.1055/s-0029-1214719
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Surveillance and treatment of duodenal adenomatosis in familial adenomatous polyposis

A.  Lepistö1 , T.  Kiviluoto1 , J.  Halttunen1 , H.  J.  Järvinen1
  • 1Department of Surgery, Helsinki University Central Hospital, Finland
Further Information

Publication History

submitted 31 October 2008

accepted after revision 17 March 2009

Publication Date:
16 June 2009 (online)

Background and study aims: Patients with familial adenomatous polyposis (FAP) are at increased risk for duodenal cancer whereas colorectal cancer is largely prevented by prophylactic colectomy. We analyzed the results of endoscopic surveillance and different treatment modalities of duodenal adenomatosis in patients with FAP.

Patients and methods: Data on endoscopies, histopathological examinations, and surgical therapies were collected from the medical histories of 129 patients with FAP. The cumulative incidences of duodenal adenomatosis and severe dysplasia and cancer were calculated using Kaplan-Meier analysis.

Results: By the age of 60 years, the cumulative incidence was 80 % for any adenomatosis and 23 % for severe dysplasia or cancer. Duodenal cancer was observed in six patients (4.7 %). Fifteen endoscopic excisions in 14 patients, and 19 open duodenotomies in 17 patients were carried out. Later, pancreaticoduodenectomy was undertaken in six (35.3 %) of these 17 patients. Altogether, 12 patients (9.3 %) underwent pancreaticoduodenectomy. Except for one patient, the indication for surgery was based on follow-up endoscopies, and none of these patients died of duodenal cancer. No postoperative deaths occurred. Seven patients (58.3 %) had major complications, four (33.3 %) of which were surgical.

Conclusions: The high incidence of severe dysplasia and cancer in duodenal polyps suggests that endoscopic surveillance is essential. Endoscopic polypectomies under sedation anesthesia have partly replaced open duodenotomies. High-risk patients with Spigelman IV adenomatosis or adenomas with persisting severe dysplasia should undergo surgery with pylorus-preserving pancreaticoduodenectomy before invasive cancer develops.

References

A. LepistöMD, PhD 

Department of Surgery
Helsinki University Central Hospital

P.O. Box 340
Helsinki
00029 HUS
Finland

Fax: +358-9-74609

Email: anna.lepisto@hus.fi

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