HIGH PREVALENCE OF ADENOMAS AND MICROADENOMAS OF THE DUODENAL PAPILLAAND PERIAMPULLARY REGION IN PATIENTS WITH FAMILIAL ADENOMATOUS POLYPOSIS

Background: Patients with familial adenomatous polyposis (FAP) are tra ditionally considered to be at high risk for duodenal-papillary and pe riampullary adenomas and cancer. Aim: To evaluate prospectively the pr evalence, histology and clinical significance of ampullary and periamp ullary macroscopic and microscopic lesions in our population of affect ed patients. Setting: Three gastroenterological departments of norther n Italian hospitals. Patient and methods: Twenty-five affected patient s were carefully investigated over a 24-month period by end-viewing an d side-viewing upper panendoscopy. Biopsies were performed on represen tative macroscopic lesions and randomly on normal-appearing papillary and periampullary mucosa. Results: Seven patients had macroscopic aden omas of the duodenal papilla, three of the periampullary region and fi ve at both sites (cumulative prevalence 40%). An additional six patien ts had macroadenomas in the rest of the duodenum (overall prevalence 6 4%). Microscopic adenomas were identified in nine and two patients in the papilla and periampullary region, respectively, and in three at bo th sites (overall prevalence 44%). Thus, a total of 17 (68%) patients presented macro- or microadenomas at these locations. The prevalence r ose to 72%, when a further patient with macroadenomas in the rest of t he duodenum only was included. Malignancy was not encountered and seve re dysplasia was observed only in a macroadenoma of the second duodena l portion. A higher frequency of macroadenomas in the papilla and peri ampullary region was significantly correlated with the presence and nu mber of such lesions in the rest of the duodenum (P = 0.04). No other significant association was detected either between micro- or macroade nomas at different sites or with the demographic, clinical and patholo gical features. Conclusion: This study confirms that the duodenal papi lla and periampullary region are sites with high prevalence of macro- and microscopic adenomas in patients with FAP. However, our data do no t seem to support a higher frequency and malignancy potential of such lesions as compared to polyps in the rest of the duodenum. Nevertheles s, these findings warrant a periodic, careful examination of the duode num with either end-viewing or side-viewing endoscopy, the need for ra ndom biopsies of the papilla and periampullary region and the removal of any larger or rapidly growing lesions detected.