scholarly journals Endoscopic ultrasound in the assessment of advanced duodenal adenomatosis in familial adenomatous polyposis

2019 ◽  
Vol 6 (1) ◽  
pp. e000336
Author(s):  
Peter L Labib ◽  
George Goodchild ◽  
James P Turbett ◽  
James Skipworth ◽  
Arjun Shankar ◽  
...  
Keyword(s):  
Familial Adenomatous Polyposis ◽  
Cancer Risk ◽  
Endoscopic Ultrasound ◽  
Ampullary Cancer ◽  
Adenomatous Polyposis ◽  
Polyp Size ◽  
Surgical Interventions ◽  
Relative Indication ◽  
Duodenal Adenomatosis

ObjectiveCurrent surveillance strategies for duodenal adenomatosis in familial adenomatous polyposis (FAP) miss malignancies and underestimate cancer risk in ampullary disease. This study aimed to evaluate the utility of endoscopic ultrasound (EUS) in the assessment of FAP patients with duodenal and/or ampullary polyposis referred for surgical intervention.DesignA retrospective analysis of FAP patients undergoing index EUS between December 2006 and May 2015 was performed. Follow-up was completed in January 2018, including review of all EUS procedures and surgical interventions (median follow-up 6 years).ResultsFifty-five patients underwent 188 EUS procedures. Six patients (11%) developed malignancy (three duodenal, three ampullary). Ampullary cancer risk was underestimated by Spigelman stage and overestimated by Kashiwagi classification. Ultrasound findings were poor predictors of malignancy, with common bile duct dilatation being the only finding present in one EUS prior to a diagnosis of ampullary cancer. The best predictors of ampullary malignancy were an ampullary polyp size >3 cm and an increase >1 cm in ampullary polyp size. Ampullary polyp size >3 cm provided the best predictive value, correctly identifying two of the three cases of ampullary cancer and both patients with high-grade dysplasia. EUS biopsy failed to detect malignancy later confirmed by surgical histology in two patients.ConclusionEUS surveillance confers little additional benefit to standard endoscopic surveillance in FAP patients. The best predictor of ampullary malignancy is an ampullary polyp >3 cm; this could be regarded as a relative indication for surgery.

Utility of endoscopic ultrasound in patients with familial adenomatous polyposis and duodenal adenomatosis

Pancreatology ◽  
2012 ◽  
Vol 12 (3) ◽  
pp. e14
Author(s):  
J.R.A. Skipworth ◽  
S. Bannoo ◽  
A. Shankar ◽  
S. Clark ◽  
G.J. Webster ◽  
...  
Keyword(s):  
Familial Adenomatous Polyposis ◽  
Endoscopic Ultrasound ◽  
Adenomatous Polyposis ◽  
Duodenal Adenomatosis

ID: 3524040 THE NATURAL HISTORY OF AMPULLARY ADENOMAS IN FAMILIAL ADENOMATOUS POLYPOSIS SYNDROME: LONG-TERM FOLLOW-UP

2021 ◽  
Vol 93 (6) ◽  
pp. AB350
Author(s):  
Achintya D. Singh ◽  
Amit Bhatt ◽  
Abel Joseph ◽  
Neal Mehta ◽  
Gautam N. Mankaney ◽  
...  
Keyword(s):  
Familial Adenomatous Polyposis ◽  
Natural History ◽  
Adenomatous Polyposis ◽  
Polyposis Syndrome ◽  
Long Term Follow Up ◽  
History Of

Utility of Mesalazine in Familial Adenomatous Polyposis: Clinical Report of Reduction of Polyp Size in Patients with Ulcerative Colitis, and Safety Examination in Familial Adenomatous Polyposis Patients

Pharmacology ◽  
2019 ◽  
Vol 104 (1-2) ◽  
pp. 51-56 ◽  
Author(s):  
Hideki Ishikawa ◽  
Michihiro Mutoh ◽  
Takashi Abe ◽  
Takeshi Nakajima ◽  
Yoji Takeuchi ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Familial Adenomatous Polyposis ◽  
High Dose ◽  
Clinical Report ◽  
Colon Polyps ◽  
Adenomatous Polyposis ◽  
Polyp Size ◽  
Double Blind ◽  
Standard Drug ◽  
Intestinal Polyp

Mesalazine is the gold standard drug for treatment of ulcerative colitis (UC). Here, we describe 4 cases of familial adenomatous polyposis (FAP) patients with UC that showed reduction of intestinal polyp diameter by mesalazine treatment. Of note, the effects of mesalazine on the development of intestinal polyps in FAP patients have not been reported, and we further investigated whether the short-term use of high-dose mesalazine (4 g/day) has harmful effects on FAP patients or not. The authors found that the treatment showed slightly adverse events in FAP patients. However, mesalazine tended to reduce the number of colon polyps in male subjects with FAP. This report provides basic information for planning a double-blind, randomized, clinical trial that aims to show mesalazine’s potential to suppress intestinal polyp development in FAP.

scholarly journals Long-term outcomes of metachronous neoplasms in the ileal pouch and rectum after surgical treatment in patients with familial adenomatous polyposis

2019 ◽  
Vol 07 (05) ◽  
pp. E691-E698 ◽  
Author(s):  
Masahiro Tajika ◽  
Tsutomu Tanaka ◽  
Makoto Ishihara ◽  
Yutaka Hirayama ◽  
Sachiyo Oonishi ◽  
...  
Keyword(s):  
Familial Adenomatous Polyposis ◽  
Ileal Pouch ◽  
Maximum Size ◽  
Incidence Rates ◽  
Adenomatous Polyposis ◽  
Significant Incidence ◽  
Long Term Follow Up ◽  
Advanced Adenomas

Abstract Background and study aims Restorative proctocolectomy has become the most common surgical option for patients with familial adenomatous polyposis (FAP). However, adenomas and even carcinomas may develop in the ileal pouch over time. The aim of this study was to evaluate the long-term incidence and nature of ileal pouch or distal ileal adenomas and carcinomas in patients with FAP. Patients and methods This was a retrospective study of 47 FAP patients with Kock’s continent ileostomy (Kock) (n = 8), ileorectal anastomosis (IRA) (n = 13), and ileal pouch-anal anastomosis (IPAA) (n = 26). Patients were followed with a standardized protocol including chromoendoscopy and biopsies of visible polyps in the ileal pouch, distal ileum, and rectum every 6 to 12 months. Results Median follow-up was 21.0 years. Overall risk of adenoma development was significantly higher in IRA patients, with incidence rates of 85 % and 100 % at 5 and 10 years’ follow-up, respectively, compared to pouch patients (Kock + IPAA) (P < 0.001). However, there was also a high frequency of adenomas in the ileal pouch mucosa, with rates of 12 %, 33 %, and 68 %, at 5, 10, and 20 years of follow-up, respectively. Maximum size of ileal pouch adenomas was significantly related to time since surgery (P = 0.0214). Six cases of advanced adenomas including two cases of adenocarcinomas developed in the ileal pouch mucosa. Conclusions There is a significant incidence of adenoma(s) in the ileal pouch of FAP patients on long-term follow-up. Regular endoscopic surveillance is recommended, not only in IRA patients, but also in pouch patients after proctocolectomy.

scholarly journals A Support Vector Machine Model Predicting the Risk of Duodenal Cancer in Patients with Familial Adenomatous Polyposis at the Transcript Levels

2020 ◽  
Vol 2020 ◽  
pp. 1-12
Author(s):  
Weiqing Liu ◽  
Jian Dong ◽  
Shumin Ma ◽  
Lei Liang ◽  
Jun Yang
Keyword(s):  
Support Vector Machine ◽  
Familial Adenomatous Polyposis ◽  
Cancer Risk ◽  
Prediction Model ◽  
Differentially Expressed Genes ◽  
Differentially Expressed ◽  
Duodenal Cancer ◽  
Support Vector ◽  
Adenomatous Polyposis ◽  
Transcript Levels

Objective. Familial adenomatous polyposis (FAP) is one major type of inherited duodenal cancer. The estimate of duodenal cancer risk in patients with FAP is critical for selecting the optimal treatment strategy. Methods. Microarray datasets related with FAP were retrieved from the Gene Expression Omnibus (GEO) database. Differentially expressed genes were identified by FAP vs. normal samples and FAP and duodenal cancer vs. normal samples. Furthermore, functional enrichment analyses of these differentially expressed genes were performed. A support vector machine (SVM) was performed to train and validate cancer risk prediction model. Results. A total of 196 differentially expressed genes were identified between FAP compared with normal samples. 177 similarly expressed genes were identified both in FAP and duodenal cancer, which were mainly enriched in pathways in cancer and metabolic-related pathway, indicating that these genes in patients with FAP could contribute to duodenal cancer. Among them, Cyclin D1, SDF-1, AXIN, and TCF were significantly upregulated in FAP tissues using qRT-PCR. Based on the 177 genes, an SVM model was constructed for prediction of the risk of cancer in patients with FAP. After validation, the model can accurately distinguish FAP patients with high risk from those with low risk for duodenal cancer. Conclusion. This study proposed a cancer risk prediction model based on an SVM at the transcript levels.

scholarly journals Gastric adenomas and their management in familial adenomatous polyposis

Endoscopy ◽  
2020 ◽  
Author(s):  
Isabel Martin ◽  
Victorine H. Roos ◽  
Chukwuemeka Anele ◽  
Sarah-Jane Walton ◽  
Victoria Cuthill ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Familial Adenomatous Polyposis ◽  
Initial Diagnosis ◽  
Gastric Adenoma ◽  
Adenomatous Polyposis ◽  
Recurrence Rates ◽  
Patient Demographics ◽  
Increased Risk ◽  
Piecemeal Resection

Abstract Background Patients with familial adenomatous polyposis (FAP) are at increased risk of developing gastric adenomas. There is limited understanding of their clinical course and no consensus on management. We reviewed the management of gastric adenomas in patients with FAP from two centers. Methods Patients with FAP and histologically confirmed gastric adenomas were identified between 1997 and 2018. Patient demographics, adenoma characteristics, and management/surveillance outcomes were collected. Results Of 726 patients with FAP, 104 (14 %; 49 female) were diagnosed with gastric adenomas at a median age of 47 years (range 19 – 80). The median size of gastric adenomas was 6 mm (range 1.5 – 50); 64 (62 %) patients had adenomas located distally to the incisura. Five patients (5 %) had gastric adenomas demonstrating high-grade dysplasia (HGD) on initial diagnosis, distributed equally within the stomach. The risk of HGD was associated with adenoma size (P = 0.04). Of adenomas > 20 mm, 33 % contained HGD. Two patients had gastric cancer at initial gastric adenoma diagnosis. A total of 63 patients (61 %) underwent endoscopic therapy for gastric adenomas. Complications occurred in three patients (5 %) and two (3 %) had recurrence, all following piecemeal resection of large (30 – 50 mm) lesions. Three patients were diagnosed with gastric cancer at median follow-up of 66 months (range 66 – 115) after initial diagnosis. Conclusions We observed gastric adenomas in 14 % of patients with FAP. Of these, 5 % contained HGD; risk of HGD correlated with adenoma size. Endoscopic resection was feasible, with few complications and low recurrence rates, but did not completely eliminate the cancer risk.

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