GASTRODUODENAL POLYPS IN FAMILIAL ADENOMATOUS POLYPOSIS

Background: Malignant degeneration of gastroduodenal polyps has been n oted in patients with familial adenomatous polyposis, To evaluate this problem further, patients with familial adenomatous polyposis were co ntacted and offered upper gastrointestinal tract endoscopy. Methods: A prospective endoscopic examination was performed in 42 patients. Resu lts: The median age of patients at endoscopy was 35 years. The duratio n of known familial adenomatous polyposis at the time of endoscopy was 8 years, Polyps were visualized in 21 patients (50%). Gastric polyps were seen in 14 patients (33%), duodenal polyps were seen in 11 patien ts (26%), and ampullary polyps were seen in 7 patients (17%). Nine pat ients (43%) had polyps in more than one site, Adenomatous change was n oted in 73% of duodenal lesions and in only 14% of gastric polyps. Sur gical intervention was required in four patients; one patient had an e arly ampullary carcinoma, and three patients had severe dysplasia invo lving the duodenum or ampulla. All four patients had undergone a previ ous screening examination, results of which were normal in three patie nts, Compared with other patients, these four patients were older (med ian age, 58 years; p = 0.02) and had a longer duration of disease (med ian duration, 25 years; p = 0.002). Conclusions: All patients with fam ilial adenomatous polyposis require lifelong endoscopic surveillance t o detect malignant degeneration, which may appear later in life.