SULINDAC IN FAMILIAL ADENOMATOUS POLYPOSI S - INTERIM RESULTS OF A PROSPECTIVE-STUDY

Several authors have reported regression of rectal polyps after admini stration of sulindac in patients with familial adenomatous polyposis ( FAP) and subtotal colectomy. However, only a few reports have been pub lished about the effect of sulindac in the intact colon of FAP-patient s. 12 patients (FAP n = 10, Lynch-I-syndrome n = 1, juvenile polyposis n = 1 / patient with intact colon n = 6, ileorectal anastomosis n = 4 , right-sided hemicolectomy n = 2) have been treated with sulindac (3x 100 mg/d orally) for 4 months. In all patients colonoscopy (if postcol ectomy, rectoscopy) with videotape documentation was performed before and after sulindac therapy. Some polyps were excised for histology. In 11/12 patients a regression of the number and size of polyps occurred . In addition, in patients with intact colon no polyps were observed p roximal to the sigmoid colon. In one patient sulindac had to be discon tinued after a 4 weeks' course because of abdominal pain. A control co lonoscopy revealed only slight reduction in polyps. In 3/12 patients n o polyps remained after sulindac. In a further 3/12 patients with init ial tubulous adenomatous polyps, only microadenomas were observed afte r treatment. We therefore conclude that sulindac is effective in FAP-p atients (and very probably in other hereditary polyposis syndromes) wi th intact colon as well as after (hemi-)colectomy in reducing the numb er and size of polyps. Long term studies are needed to clarify the opt imal dosage, treatment time period, and long term potential for develo pment of carcinoma under sulindac treatment.