Introduction: Over 90% of the patients with familial adenomatous polyposis (FAP) will develop duodenal adenomas.
Aim: The aim of this study was to evaluate the effectiveness and safety of endoscopic excision of large duodenal adenomas in FAP patients.
Methods: All FAP patients from a familial risk clinic submitted to endoscopic therapy for duodenal adenomas ≥10 mm between January 2010 and February 2021 were included.
Results: From 151 FAP families, 22 patients (50 lesions) were included: 54.5% female; median follow-up 8.5 (IQR: 5.8-12.3) years after the first endoscopy. First therapeutic endoscopy occurred at a median age of 41.0 years (IQR: 33.0-58.2). Repeat therapeutic endoscopy was required in 54.5% of patients. Median size of the largest adenoma was 15 mm (IQR: 10-18 mm); resection was piecemeal in 63.1% and en bloc in the remaining. In 2 cases, the resection was incomplete (fibrosis due to previous resection and difficult positioning). Complications occurred in 6.3% of the resected lesions (4 patients): 2 immediate (bleeding, perforation); 4 in the first week (1 bleeding, 2 mild pancreatitis, 1 perforation requiring surgery; the latter two after ampullectomy). Histology revealed low-grade dysplasia adenomas in 90.1%; no adenocarcinomas were found. One patient with Spigelman stage IV disease not amenable to endoscopic control underwent elective duodenopancreatectomy (without duodenal cancer).
Conclusion: Endoscopic surveillance and treatment of duodenal adenomas in FAP patients was safe and effective in the prevention of duodenal cancer.
Introdução: Mais de 90% dos doentes com Polipose Adenomatosa Familiar (PAF) desenvolvem adenomas duodenais.
Objetivo: Avaliar a eficacia e seguranca da excisao endoscopica de adenomas duodenais em doentes com PAF.
Métodos: Incluidos todos os doentes com PAF submetidos a terapeutica endoscopica de adenomas duodenais ≥10 mm entre janeiro/2010-fevereiro/2021.
Resultados: Em 151 familias com PAF, incluidos 22 doentes (50 lesoes): 54.5% mulheres; mediana do follow-up 12.3 (IQR: 6.0–19.0) anos. Primeira endoscopia terapeutica (ressecao de polipos duodenais ≥10 mm) ocorreu numa mediana de idades 41.0 (IQR: 33.0–58.2) anos. Em 54.5% dos casos, foi necessaria uma nova endoscopia terapeutica. Dimensao mediana do maior adenoma: 15 mm (IQR: 10–18 mm); ressecao realizada em piecemeal em 63.1% e em bloco nos restantes. Em dois casos, a ressecao endoscopica foi incompleta (fibrose em local de ressecao previa:1; posicionamento: 1). Complicacoes em 6.3% das lesoes ressecadas (4 doentes): 2 imediatas (hemorragia e perfuracao, manejadas endoscopicamente); 4 na primeira semana (1 hemorragia controlada endoscopicamente, 2 pancreatites ligeiras tratadas conservadoramente, 1 perfuracao com necessidade de cirurgia; as duas ultimas apos ampulectomia). A avaliacao histologica revelou adenomas com displasia de baixo grau em 90.1%; nenhum adenocarcinoma. Um doente com doenca Spigelman IV nao controlavel endoscopicamente realizou duodenopancreatectomia (sem cancro).
Conclusão: A vigilancia e tratamento endoscopicos de adenomas duodenais em doentes com PAF revelaram-se seguros e eficazes na prevencao de cancro duodenal.
Keywords: Adenomas; Duodenum; Endoscopic mucosal resection; Endoscopy; Familial adenomatous polyposis.
Copyright © 2022 by The Author(s). Published by S. Karger AG, Basel.