SAFETY AND EFFICACY OF INTENSIVE ENDOSCOPIC INTERVENTION INCLUDING COLD POLYPECTOMY FOR DUODENAL ADENOMAS IN PATIENTS WITH FAMILIAL ADENOMATOUS POLYPOSIS: A PROSPECTIVE PHASE II COHORT STUDY

Aims To investigate the efficacy and safety of intensive endoscopic intervention for non-ampullary multiple duodenal adenoma (NMDA) in patients with FAP in a large prospective cohort.

Methods This is a single-center prospective cohort study conducted at a Japanese cancer referral center. Patients with FAP with Spigelman Stage (SS)≥I NMDA, aged≥20 years were eligible for inclusion in the study. The primary endpoint was a down-staging of SS at 1-year follow-up endoscopy compared with the SS at the first intervention.

Results 58 patients [median (range) age: 37 (20-70), 29 male (50%)] with 2424 [median (range) number of polyps: 38 (5-166)] duodenal polyps were enrolled. SS at enrollment was 6 (10%) in Stage II, 24 (41%) in Stage III, and 24 (48%) in Stage IV. The median (range) procedure time was 33 (15–96) minutes. The Median (range) size of maximum removed polyp in one session was 10 (2-50). Cold snare polypectomy was performed in 98% (57/58), cold forceps polypectomy in 2%. Underwater EMR was performed for 4 lesions. None of the 57 patients had perforation and delayed bleeding. SS at 1yr follow-up endoscopy was 1 (2%) in Stage 0, 2 (3%) in Stage I, 28 (49%) in Stage II, 20 (18%) in Stage III, and 4 (7%) in Stage IV. Therefore, downstaging in SS was obtained in 72% (39/54, 95% CI; 59-82) and stable disease in 22% (12/54).

Conclusions Intensive endoscopic intervention including cold polypectomy seems safe and effective. Further long-term outcomes should be assessed in this cohort study.

 

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Publication History

Article published online:
14 April 2022