Driffa Moussata, MD, PhD from Lyon Sud Hospital in Lyon, France presents his Original Article “Endoscopic treatment of severe duodenal polyposis as an alternative to surgery for patients with familial adenomatous polyposis.”
After colectomy, the duodenum, and the periampullary region in particular, is a major site of adenoma development occurring in up to 100% of patients. The severity of duodenal polyposis can be quantified using the Spigelman staging system and at this stage, some authors recommend surgery because of the risk of cancer. But this surgery presents high morbidity and mortality rates and moreover there is a risk of adenoma recurrence after surgery in the distal duodenum or jejunum, which may be more difficult to reach endoscopically after PD. However, very little data is available regarding the endoscopic treatment of FAP patients with duodenal polyposis, especially in severe polyposis (stage IV).
Figure 2. Evolution of the average Spigelman score with a 95% confidence interval.
Because evidence-based data is very scarce on therapeutic endoscopy in stage IV of duodenal polyposis. In our opinion, stage IV duodenal polyposis is accessible to endoscopic treatment, whereas some authors recommend surgery.
The present series shows that FAP patients with stage IV duodenal polyposis can be managed endoscopically with a high efficiency rate (> 90% down staging) and that they do not develop invasive cancer during long-term follow-up (a mean of more than 6 years), providing a strict, regular and optimized endoscopic follow-up is in place. Based on our results, we can recommend an endoscopic approach performed by experienced teams, with a systematic, strict and relatively aggressive endoscopic procedure, which allows significant down-staging of duodenal polyposis and the prevention of cancer development with a long follow-up.
Find the abstract for this article online here.
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