SURVEILLANCE OF DUODENAL POLYPS IN FAMILIAL ADENOMATOUS POLYPOSIS - PROGRESS REPORT

Familial adenomatous polyposis (FAP) is characterized by the presence of premalignant adenomas of the large and small bowel. Prophylactic co lectomy deals with the risk for colon cancer, leaving duodenal cancer as the leading cause of death. Although most FAP patients have duodena l adenomas, only approximately 5% develop duodenal cancer. This study looks at progression of duodenal polyps with time. The outcome of endo scopic surveillance in the duodenum of 70 patients with familial adeno matous polyposis was determined. A mean of 40 months elapsed between e ndoscopies. Outcome was measured using video comparison and a staging system that includes histological assessment. Duodenal cancer develope d in one patient, and was suspected in two others. The stage of duoden al polyposis worsened in another seven patients. When histology was ig nored, comparison of video recordings in 52 patients showed a worsenin g in 21 (40%). In conclusion, further surveillance appears warranted s o that patients at high risk for duodenal cancer might receive early t reatment. Should slow progression of duodenal polyposis be shown to be associated with low risk, then most patients can be safely offered le ss frequent endoscopies than hitherto.