Author Discussion Series- Maria Lopez-Ceron Pinilla

An original article from the Clinical Endoscopy section of the April issue: “The role of high-resolution endoscopy and narrow-band imaging in the evaluation of upper GI neoplasia in familial adenomatous polyposis” by Maria Lopez-Ceron, MD, Frank J. C. van den Broek, MD, PhD, Elisabeth M. Mathus-Vliegen, MD, PhD, Karam S. Boparai, MD, PhD, Susanne van Eeden, MD, PhD, Paul Fockens, MD, PhD, Evelien Dekker, MD, PhD

Maria Lopez-Ceron Pinilla from the Gastroenterology Department at the Hospital Clinic Barcelona writes about her article “The role of high-resolution endoscopy and narrow-band imaging in the evaluation of upper GI neoplasia in familial adenomatous polyposis.”

The Spigelman classification is used worldwide to stratify the risk of duodenal cancer in familial adenomatous polyposis (FAP) patients. In recent years, novel endoscopic techniques such as high-resolution endoscopy (HRE) and narrow-band imaging (NBI) have been introduced. These technologies may improve the detection of lesions, but their impact on Spigelman classification and its risk-correlation has not been established. HRE and NBI may also identify polyps at risk for malignant degeneration, allowing a better prediction of the risk of developing duodenal cancer. The primary aim of our study was to identify endoscopic features of advanced histology in duodenal adenomas with HRE and NBI. Secondarily we aimed to compare HRE and NBI for the assessment of the Spigelman classification of duodenal adenomatosis and to compare the accuracy of both techniques in the detection of gastric polyps.

We believed it was important to conduct this study because the role of new technologies has not been evaluated in FAP patients with duodenal adenomatosis.

Tubular adenomas with low-grade dysplasia in the antrum. A, Zoomed picture with high-resolution endoscopy. B, Zoomed picture with narrow-band imaging.

NBI did not significantly improve the detection of duodenal and gastric polyps in comparison with HRE. These results are in concordance with a previous study with high-resolution chromoendoscopy. After a systematized approach with HRE and NBI images, the only feature associated with advanced histology was size >1cm. Hence we can conclude that NBI does not add relevant additional information to HRE in the evaluation of gastrointestinal lesions in FAP patients. Both NBI and HRE have a limited role in characterization of adenomas at high risk of degeneration. As large lesions will contain advanced histology more often, it could be argued that endoscopic polypectomy for all polyps larger than 1 cm should be performed. If this strategy indeed prevents major duodenal surgery and/or duodenal cancer should be subject of a large prospective trial. We believe that the Spigelman classification should be re-evaluated and might be simplified by putting more emphasis on size, extension, location (papillary or extra-papillary), villous and tubulovillous architecture and high-grade dysplasia.

Read the abstract of this article here.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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