Estado actual del seguimiento del área gastroduodenal en la poliposis adenomatosa familiar

Gastroduodenal involvement in patients with familial adenomatous polyposis. Prospective study of the nature and evolution of polyps: evaluation of the treatment and surveillance methods applied

OBJECTIVES

Analysis of the incidence rate and the evolution of duodenal and stomach polyps in our familial adenomatous polyposis (FAP) patients, the suitability of the surveillance method and the cancer-preventing treatment applied and the analysis of the complications arising from each procedure employed.

MATERIALS AND METHODS

Twenty-nine patients diagnosed with FAP underwent study and endoscopic surveillance of the upper digestive tract. Front-view and side-view endoscopies were used. Papillary biopsies were performed even when the papilla were macroscopically normal. The Spigelman classification was used to determine the seriousness of the condition and to establish the surveillance and treatment intervals.

RESULTS

Duodenal and/or papillary polyps were presented by 79.3% of the patients. Endoscopic polypectomy was performed in 13 patients with duodenal polyps. Endoscopic polypectomies for the papilla were performed in all patients. One patient required a cephalic duodenopancreatectomy and another endoscopic ampullectomy. The condition did not become cancerous in any of the patients who underwent surveillance. We report two complications arising from treatment: one postpolypectomy haemorrhage and one stenosis of the biliary-enteric anastomosis after cephalic duodenopancreatectomy.

CONCLUSION

Our study shows a high incidence rate of duodenal polyps in FAP patients. A minute examination of the duodenum and papilla is necessary, using side-view endoscopes and duodenal papilla biopsies even when papilla appears to be normal. None of the patients having completed the surveillance and the prescribed treatment developed cancer and all have a low Spigelman score. This method, therefore, seems to be adequate for the treatment and surveillance of duodenal polyps.

[Familial adenomatous polyposis]

Familial adenomatous polyposis is a rare genetic disease characterized by the development of more than a hundred adenomatous polyps in the colorectal area, as well as by extracolonic manifestations. Without treatment, this inherited disease, usually transmitted by autosomal dominant inheritance, predisposes to colorectal cancer. Treatment must be preceded by counseling about the nature of the syndrome and by recommendations for the optimal management and surveillance of the disease. Currently, prophylactic surgical therapy is imperative. However, the type of surgical technique used depends mainly on the severity of the polyposis phenotype, the age of the patient at diagnosis, and a series of special clinical circumstances. Lifetime follow-up of all patients is required. This article reviews the main studies published on familial adenomatous polyposis in order to provide an update on the most appropriate management of these patients.