DUODENAL EVALUATION IN ADENOMATOUS POLYPOSIS - IS THERE ANY ROLE FOR TAILORING SURVEILLANCE?

Aims Familial Adenomatous Polyposis (FAP) and MUTYH-Associated Polyposis (MAP) are associated with a high risk of small bowel lesions both in duodenum, ampulla and distally in the jejunum and ileon. Our aim was to evaluate the correlation between the severity of duodenal polyposis and the presence of ampullary adenoma and small-bowel polyps.

Methods A prospectively database of patients followed in our institution for colorectal polyposis (defined by genetic criteria - APC mutation (n=46) or MYH biallelic mutation (n=17) - or by clinicopathological criteria (>20 adenomas) (n=27)) was assessed retrospectively. Only adult patients (≥18 years old) that had at least one upper endoscopy (n=90) were included. 35% of patients were submitted to small bowel imaging.

Results The Spigelman score in the first upper endoscopy was 0, 1, 2 and 3 in 54%, 30%, 9% and 7% of patients with FAP respectively. 30.4% of all patients (n=14) had ampullary adenoma (11 low grade displasia, 4 high grade displasia). There was a significant association between the Spigelman score and the presence of ampullary adenoma (p< 0.01). Three patients had small-bowel lesions diagnosed by capsule endoscopy (6.5%) and their Spigelman score was 1, 2 and 3. None of them needed endoscopic or surgical treatment.

Among the non-FAP patients, all were classified as Spigelman 0 except one (score 1). None of the patients was diagnosed with ampullary adenoma or small bowel lesions.

Conclusions Our results support a suggestion of tailoring surveillance among patients with polyposis by including ampullary assessment only for those with FAP with more advanced duodenal adenoma stages. Further studies are needed to clarify the surveillance benefit in non-FAP polyposis patients.