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Cwaliński J, Zasada W, Cholerzyńska H, Andrzejewska W, Michalak H, Banasiewicz T, Paszkowski J. Endoscopic Surveillance after (Procto)Colectomy with Gastrointestinal Reconstruction in Patients with Familial Adenomatous Polyposis (FAP)-Principles, Goals and Practical Aspects Based on 12 Years of Observation. Life (Basel) 2024; 14:1000. [PMID: 39202742 PMCID: PMC11355371 DOI: 10.3390/life14081000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 08/05/2024] [Accepted: 08/09/2024] [Indexed: 09/03/2024] Open
Abstract
(1) Background: Familial adenomatous polyposis (FAP) is a hereditary condition characterized by the development of numerous adenomas in the large intestine, often necessitating colectomy due to an elevated risk of colorectal cancer. Despite surgical intervention, adenomas frequently recur, underscoring the importance of ongoing surveillance. This study evaluates the outcomes of a 12-year endoscopic follow-up after colectomy and gastrointestinal reconstruction for FAP. (2) Methods: A retrospective analysis was conducted on 41 FAP patients who underwent at least one postoperative endoscopic examination. Assessments of the pouch or rectum were performed every 12-18 months following ileorectal anastomosis and every 18-24 months after ileal pouch-anal anastomosis. Follow-up biopsies were assessed using the adopted Spigelman classification. (3) Results: Postoperative pathology revealed invasive colorectal cancer in three patients. Abdominoperineal resection was performed in two cases due to secondary invasive carcinoma, and one T1 tumor was radically removed with ESD. One patient underwent radical pouch excision following a nodal pelvic recurrence of rectal cancer. Over a 12-year observation period, the mean Spigelman score increased by 2 points, and the proportion of patients with low-grade polypoid lesions decreased. The quantity or size of polyps increased in 24 patients, decreased in 8 patients, and remained stable in 9 patients. In four patients, granular, laterally spreading tumors were discovered in the rectal stump. (4) Conclusions: Regular endoscopic surveillance in FAP patients facilitates early identification of neoplastic and inflammatory changes. The downstaging potential highlights the effectiveness of early interventions. While the Spigelman classification assessed polyps well, it did not predict cancer occurrence. A notable number of patients had invasive cancer at the time of surgery, underscoring the importance of early surgical qualification, which is particularly crucial for identifying upstaging or secondary cancer.
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Affiliation(s)
- Jarosław Cwaliński
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, 61-701 Poznań, Poland; (W.Z.); (H.C.); (W.A.); (H.M.); (T.B.); (J.P.)
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Papanikolaou IS, Tziatzios G, Gkolfakis P, Triantafyllou K. Full spectrum endoscopy for an easy and adequate visualization of Vater's papilla. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:267. [PMID: 30094253 DOI: 10.21037/atm.2018.04.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Patients with classical familial adenomatous polyposis (FAP) are at high risk for developing colorectal cancer (CRC) and duodenal adenomas. Current guidelines recommend to start duodenal screening at the age of 25-30 years and standard upper gastrointestinal (GI) endoscopy is considered inadequate for an optimal visualization of the duodenum. We used the Full-Spectrum Endoscopy® (FUSE®; EndoChoice Inc., Atlanta, GA, USA) esophagogastroduodenoscope (FUSE-EGD) for an upper GI screening procedure of a 20-year-old Caucasian male with classical FAP. The pioneer design of the FUSE-EGD allowed an easy and accurate examination of the ampulla with standard scope manipulation maneuvers.
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Affiliation(s)
- Ioannis S Papanikolaou
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, ''Attikon" University General Hospital, Athens, Greece
| | - Georgios Tziatzios
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, ''Attikon" University General Hospital, Athens, Greece
| | - Paraskevas Gkolfakis
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, ''Attikon" University General Hospital, Athens, Greece
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, ''Attikon" University General Hospital, Athens, Greece
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Sulbaran M, Campos FG, Ribeiro U, Kishi HS, Sakai P, de Moura EGH, Bustamante-López L, Tomitão M, Nahas SC, Cecconello I, Safatle-Ribeiro AV. Risk factors for advanced duodenal and ampullary adenomatosis in familial adenomatous polyposis: a prospective, single-center study. Endosc Int Open 2018; 6:E531-E540. [PMID: 29713679 PMCID: PMC5909774 DOI: 10.1055/a-0577-2650] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 12/18/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND STUDY AIMS To determine the clinical features associated with advanced duodenal and ampullary adenomas in familial adenomatous polyposis. Secondarily, we describe the prevalence and clinical significance of jejunal polyposis. PATIENTS AND METHODS This is a single center, prospective study of 62 patients with familial adenomatous polyposis. Duodenal polyposis was classified according to Spigelman and ampullary adenomas were identified. Patients with Spigelman III and IV duodenal polyposis underwent balloon assisted enteroscopy. Predefined groups according to Spigelman and presence or not of ampullary adenomas were related to the clinical variables: gender, age, family history of familial adenomatous polyposis, type of colorectal surgery, and type of colorectal polyposis. RESULTS Advanced duodenal polyposis was present in 13 patients (21 %; 9 male) at a mean age of 37.61 ± 13.9 years. There was a statistically significant association between family history of the disease and groups according to Spigelman ( P = 0.03). Seven unrelated patients (6 male) presented ampullary adenomas at a mean age of 36.14 ± 14.2 years. The association between ampullary adenomas and extraintestinal manifestations was statistically significant in multivariate analysis ( P = 0.009). Five endoscopic types of non-ampullary adenoma were identified, showing that lesions larger than 10 mm or with a central depression presented foci of high grade dysplasia. Among 28 patients in 12 different families, a similar Spigelman score was identified; 10/12 patients (83.3 %) who underwent enteroscopy presented small tubular adenomas with low grade dysplasia in the proximal jejunum. CONCLUSIONS Advanced duodenal polyposis phenotype may be predictable from disease severity in a first-degree relative. Ampullary adenomas were independently associated with the presence of extraintestinal manifestations.
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Affiliation(s)
- M. Sulbaran
- Gastrointestinal Endoscopy Service, Gastroenterology Department, Clinics Hospital, University of Sao Paulo School of Medicine, Sao Paulo, Brazil,Corresponding author Marianny Sulbaran, MD MSc Gastrointestinal Endoscopy Service, Gastroenterology Department, Clinics Hospital, University of Sao Paulo School of MedicineAv. Dr. Eneas de Carvalho Aguiar, 255 – Block 3 – Cerqueira Cesar, Sao Paulo – SP, 01246-000Brazil+55-11-31494790
| | - F. G. Campos
- Surgical Division, Gastroenterology Department, Clinics Hospital, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - U. Ribeiro
- Surgical Division, Gastroenterology Department, Clinics Hospital, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - H. S. Kishi
- Pathology Department, Clinics Hospital, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - P. Sakai
- Gastrointestinal Endoscopy Service, Gastroenterology Department, Clinics Hospital, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - E. G. H. de Moura
- Gastrointestinal Endoscopy Service, Gastroenterology Department, Clinics Hospital, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - L. Bustamante-López
- Surgical Division, Gastroenterology Department, Clinics Hospital, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - M. Tomitão
- Pathology Department, Clinics Hospital, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - S. C. Nahas
- Surgical Division, Gastroenterology Department, Clinics Hospital, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - I. Cecconello
- Surgical Division, Gastroenterology Department, Clinics Hospital, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - A. V. Safatle-Ribeiro
- Gastrointestinal Endoscopy Service, Gastroenterology Department, Clinics Hospital, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
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Wilhelm A, Galata C, Beutner U, Schmied BM, Warschkow R, Steffen T, Brunner W, Post S, Marti L. Duodenal localization is a negative predictor of survival after small bowel adenocarcinoma resection: A population-based, propensity score-matched analysis. J Surg Oncol 2017; 117:397-408. [DOI: 10.1002/jso.24877] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 09/09/2017] [Accepted: 09/18/2017] [Indexed: 12/12/2022]
Affiliation(s)
| | - Christian Galata
- Department of Surgery; Universitätsmedizin Mannheim, Medical Faculty Mannheim, University of Heidelberg; Mannheim Germany
| | - Ulrich Beutner
- Department of General, Visceral, Endocrine and Transplantation Surgery; Kantonsspital St. Gallen; St. Gallen Switzerland
| | - Bruno M. Schmied
- Department of General, Visceral, Endocrine and Transplantation Surgery; Kantonsspital St. Gallen; St. Gallen Switzerland
| | - Rene Warschkow
- Department of General, Visceral, Endocrine and Transplantation Surgery; Kantonsspital St. Gallen; St. Gallen Switzerland
- Institute of Medical Biometry and Informatics; University of Heidelberg; Heidelberg Germany
| | - Thomas Steffen
- Department of General, Visceral, Endocrine and Transplantation Surgery; Kantonsspital St. Gallen; St. Gallen Switzerland
| | - Walter Brunner
- Department of General, Visceral, Endocrine and Transplantation Surgery; Kantonsspital St. Gallen; St. Gallen Switzerland
| | - Stefan Post
- Department of Surgery; Universitätsmedizin Mannheim, Medical Faculty Mannheim, University of Heidelberg; Mannheim Germany
| | - Lukas Marti
- Department of Surgery; Universitätsmedizin Mannheim, Medical Faculty Mannheim, University of Heidelberg; Mannheim Germany
- Department of General, Visceral, Endocrine and Transplantation Surgery; Kantonsspital St. Gallen; St. Gallen Switzerland
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