Progression and Management of Duodenal Neoplasia in Familial Adenomatous Polyposis: A Cohort Study.
Ann Surg
; 261(6): 1138-44, 2015 Jun.
Article
in En
| MEDLINE
| ID: mdl-24950262
ABSTRACT
OBJECTIVE:
To describe the natural history and outcomes of surveillance of duodenal neoplasia in familial adenomatous polyposis (FAP).BACKGROUND:
Duodenal cancer is the most common cause of death in FAP.METHODS:
Cohort study of patients prospectively enrolled in an upper endoscopic surveillance protocol from 1982 to 2012. The duodenum was assessed by side-viewing endoscopy and classified as stage 1 to 5 disease. Endoscopic and/or operative interventions were performed according to stage.RESULTS:
There were 218 patients in the protocol (98 with advanced stage). They had a median of 9 endoscopies (range 2-25) over a median of 11 years (range 1-26). Median age at diagnosis of stage 3 disease (adenoma 2.1-10 mm) was 41 years and stage 4 disease (adenoma >10 mm) was 45 years. Median time from first esophagogastroduodenoscopy to stage 4 disease was 22.4 years. The risk of stage 4 disease was 34.3% [95% confidence interval (CI) 23.8-43.4] at 15 years. In multivariate analysis, sex, type of colorectal surgery, years since colorectal surgery, and stage were significantly associated with risk of progression to stage 4 disease. Five of 218 (2.3%) patients developed duodenal cancer at median age of 58 years (range 51-65). The risk of developing duodenal cancer was 2.1% (95% CI 0-5.2) at 15 years.CONCLUSIONS:
Patients with advanced duodenal polyposis progress in the severity of disease (size and degree of dysplasia); however, the rate of progression to carcinoma is slow. Aggressive endoscopic and surgical intervention, especially in the presence of large polyps and high-grade dysplasia, appears to be effective in preventing cancer deaths in FAP.
Full text:
1
Database:
MEDLINE
Main subject:
Adenoma
/
Adenomatous Polyposis Coli
/
Duodenal Neoplasms
Type of study:
Diagnostic_studies
/
Etiology_studies
/
Guideline
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
/
Screening_studies
Limits:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
Ann Surg
Year:
2015
Type:
Article