TY - JOUR
T1 - Endoscopic management of duodenal adenomas in patients with familial adenomatous polyposis
AU - Roos, Victorine H.
AU - Bastiaansen, Barbara A.
AU - Kallenberg, Frank G. J.
AU - Aelvoet, Arthur S.
AU - Bossuyt, Patrick M. M.
AU - Fockens, Paul
AU - Dekker, Evelien
N1 - Funding Information: DISCLOSURE: The following authors disclosed financial relationships: B. A. Bastiaansen: Speaker for Olympus, Tillotts Pharma AG, and Ovesco Endoscopy AG. P. Fockens: Consultant for Olympus , and Cook Medical , Ethicon Endosurgery; research grant from Boston Scientific. E. Dekker: Equipment loan and research grant from FujiFilm; consultant for FujiFilm, Olympus, Tillots Pharma AG, GI Supply, and CPP-FAP (Cancer Prevention Pharmaceuticals, Inc); speaker for Olympus, Roche , and GI Supply; supervisory board of eNose. All other authors disclosed no financial relationships. Funding Information: DISCLOSURE: The following authors disclosed financial relationships: B. A. Bastiaansen: Speaker for Olympus, Tillotts Pharma AG, and Ovesco Endoscopy AG. P. Fockens: Consultant for Olympus, and Cook Medical, Ethicon Endosurgery; research grant from Boston Scientific. E. Dekker: Equipment loan and research grant from FujiFilm; consultant for FujiFilm, Olympus, Tillots Pharma AG, GI Supply, and CPP-FAP (Cancer Prevention Pharmaceuticals, Inc); speaker for Olympus, Roche, and GI Supply; supervisory board of eNose. All other authors disclosed no financial relationships. Publisher Copyright: © 2021 American Society for Gastrointestinal Endoscopy Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/2
Y1 - 2021/2
N2 - Background and Aims: Almost all patients with familial adenomatous polyposis (FAP) develop duodenal adenomas, with a 4% to 18% risk of progression into duodenal cancer. Prophylactic endoscopic resection of duodenal adenomas may prevent cancer and is considered safer than surgical alternatives; however, data are limited. Therefore, the aim of this study was to assess safety and effectiveness of endoscopic duodenal interventions in patients with FAP. Methods: We performed a historical cohort study including patients with FAP who underwent an endoscopic duodenal intervention between 2002 and 2018. Safety was defined as adverse event rate per intervention and effectiveness as duodenal surgery–free and duodenal cancer–free survival. Change in Spigelman stage was assessed as a secondary outcome. Results: In 68 endoscopy sessions, 139 duodenal polypectomies were performed in 49 patients (20 men; median age, 43). Twenty-nine patients (14 men; median age, 49) underwent a papillectomy. After polypectomy, 9 (13%) bleedings and 1 (2%) perforation occurred, all managed endoscopically. Six (21%) bleedings (endoscopically managed), 4 (14%) cases of pancreatitis, and 1 (3%) perforation (conservatively treated) occurred after papillectomy. Duodenal surgery–free survival was 74% at 89 months after polypectomy and 71% at 71 months after papillectomy; no duodenal cancers were observed. After a median of 18 months (interquartile range, 10-40; range, 3-121) after polypectomy, Spigelman stages were significantly lower (P <.01). Conclusions: In our FAP patients, prophylactic duodenal polypectomies were relatively safe. Papillectomies showed substantial adverse events, suggesting its benefits and risk should be carefully weighted. Both were effective, however, because surgical interventions were limited and none developed duodenal cancer.
AB - Background and Aims: Almost all patients with familial adenomatous polyposis (FAP) develop duodenal adenomas, with a 4% to 18% risk of progression into duodenal cancer. Prophylactic endoscopic resection of duodenal adenomas may prevent cancer and is considered safer than surgical alternatives; however, data are limited. Therefore, the aim of this study was to assess safety and effectiveness of endoscopic duodenal interventions in patients with FAP. Methods: We performed a historical cohort study including patients with FAP who underwent an endoscopic duodenal intervention between 2002 and 2018. Safety was defined as adverse event rate per intervention and effectiveness as duodenal surgery–free and duodenal cancer–free survival. Change in Spigelman stage was assessed as a secondary outcome. Results: In 68 endoscopy sessions, 139 duodenal polypectomies were performed in 49 patients (20 men; median age, 43). Twenty-nine patients (14 men; median age, 49) underwent a papillectomy. After polypectomy, 9 (13%) bleedings and 1 (2%) perforation occurred, all managed endoscopically. Six (21%) bleedings (endoscopically managed), 4 (14%) cases of pancreatitis, and 1 (3%) perforation (conservatively treated) occurred after papillectomy. Duodenal surgery–free survival was 74% at 89 months after polypectomy and 71% at 71 months after papillectomy; no duodenal cancers were observed. After a median of 18 months (interquartile range, 10-40; range, 3-121) after polypectomy, Spigelman stages were significantly lower (P <.01). Conclusions: In our FAP patients, prophylactic duodenal polypectomies were relatively safe. Papillectomies showed substantial adverse events, suggesting its benefits and risk should be carefully weighted. Both were effective, however, because surgical interventions were limited and none developed duodenal cancer.
UR - http://www.scopus.com/inward/record.url?scp=85091606034&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.gie.2020.05.065
DO - https://doi.org/10.1016/j.gie.2020.05.065
M3 - Article
C2 - 32535190
SN - 0016-5107
VL - 93
SP - 457
EP - 466
JO - Gastrointestinal Endoscopy
JF - Gastrointestinal Endoscopy
IS - 2
ER -