RESUMO
BACKGROUND: Gastric polyposis is common in familial adenomatous polyposis. However, the incidence and risk factors for gastric cancer are unclear. We aimed to evaluate the incidence of gastric cancer and associated risk factors in a large familial adenomatous polyposis population. METHODS: Retrospective review of patients with familial adenomatous polyposis undergoing upper endoscopy at Mayo Clinic from 1989 to 2023. Cumulative incidence of gastric cancer(95% confidence intervals) were calculated using Kaplan-Meier survival approaches. Associations of clinical characteristics with development of gastric cancer were examined using Cox proportional hazards regression. RESULTS: 337 patients underwent 2,502 endoscopies with a median of 10.4 (IQR 3.9-17.2) years of endoscopic surveillance. At any time during surveillance, 294 (87%) patients had gastric polyps, 200 (59%), fundic gland polyps; 116 (34%), low-grade dysplasia; and 11 (3.3%), high-grade dysplasia. Amongst these, only 6 (2%) patients developed gastric cancer; 5 with high-grade dysplasia (3 (50%) on prior endoscopy, 2 (33%) at time of cancer diagnosis; and 1 (16%) had low-grade dysplasia on prior endoscopy. The 10-year cumulative incidence of gastric cancer is 0% with no polyps, 1% with polyps, 6% with low-grade dysplasia, 11% with polyps >2cm, and 20% with high-grade dysplasia. Both high-grade dysplasia and polyps >2cm had a strong association with the development of gastric cancer (p<0.001). CONCLUSION: While the overall risk of gastric cancer in familial adenomatous polyposis is low, outcomes remain poor. Gastric cancer can be predicted by endoscopic findings and specific GC surveillance guidelines are imperative to improve detection rates and guide timely intervention.
RESUMO
While the endoscopic management of surgical complications like leaks, fistulas, and perforations is rapidly evolving, its core principles revolve around closure, drainage, and containment. Effectively managing these conditions relies on several factors, such as the underlying cause, chronicity of the lesion, tissue viability, co-morbidities, availability of devices, and expertise required to perform the endoscopy. In contrast to acute perforation, fistulas and leaks often demand a multimodal approach requiring more than one session to achieve the required results. Although the ultimate goal is complete resolution, these endoscopic interventions can provide clinical stability, enabling enteral feeding to lead to early hospital discharge or elective surgery. In this discussion, we emphasize the current state of knowledge and the prospective role of endoscopic interventions in managing surgical complications.