Aims To analyze the quality parameters of endoscopic surveillance and their association
with the development of advanced neoplasia in the rectal remnant or reservoir among
familial adenomatous polyposis (FAP) patients after prophylactic (procto)colectomy.
Methods A retrospective observational study was conducted including FAP patients who underwent
prophylactic colectomy or proctocolectomy and were registered between 1983 and 2022
at the Hospital Clínic de Barcelona. Advanced neoplasia was defined as an adenoma≥10
mm, high-grade dysplasia or adenocarcinoma in the rectal remnant or reservoir. Numerical
variables were analyzed using the Mann-Whitney U test, and categorical variables were
evaluated with the Chi-square test. Logistic regression was performed to identify
independent variables associated with the development of advanced neoplasia.
Results Of the 85 eligible patients, 61 (64% women; median age, 53 years [range, 39–59])
met the inclusion criteria. Seven patients (11.5%) were diagnosed with advanced neoplasia,
of whom six had ileorectal anastomosis and one had ileoanal pouch anastomosis. Of
these seven patients, three (43%) developed cancer, while four (57%) presented advanced
adenomas in the rectal remnant or reservoir. Patients with advanced neoplasia(AN)
underwent lower-quality endoscopies compared to those without AN: the use of high-definition
endoscopes was 42.9% vs. 94.4% (p=0.002), retroflexion was performed in 14.2% vs.
68.5% (p=0.005), adequate bowel preparation was achieved in 42.8% vs. 87% (p=0.004),
procedures were performed in a dedicated endoscopy program in 28.5% vs. 79.6% (p=0.004),
and the mean number of polyps removed was 1.1±0.9 vs. 3.4±4.2 (p=0.001), respectively.
In the multivariable analysis, the only independent variable associated with the development
of advanced neoplasia was the non-use of high-definition endoscopes [1]
[2]
[3]
[4]
[5].
Conclusions The development of advanced neoplasia is associated with lower quality in endoscopic
surveillance parameters among FAP patients who underwent prophylactic (procto)colectomy.
These findings highlight the need to establish specific quality indicators to optimize
endoscopic surveillance in this high-risk population.
