Familial adenomatous polyposis: Prevalence of adenomas in the ileal pouch after restorative proctocolectomy

Objectives To determine the prevalence of adenomas in ileal pouches from pa tients with familiar adenomatous polyposis (FAP) and to determine whether a correlation exists between the presence of pouch adenomas and duodenal ade nomas and the site of the adenomatous polyposis coil gene mutation. Summary Background Data Restorative proctocolectomy can markedly reduce the risk of colorectal adenocarcinoma in FAP patients. However, adenomas with the potential to progress to adenocarcinoma can develop in the duodenum, il eum, and continent ileostomy after restorative proctocolectomy. More recent ly, adenomas have been described in the ileal pouch after ileoanal anastomo sis. Methods Pouch endoscopy was offered to 167 patients with FAP who had underg one restorative proctocolectomy between January 1984 and December 1996. Results Adenomas were found in 35% of the 85 ileal pouches examined. No inv asive carcinomas were noted. The risk of developing one or more adenomas at 5, 10, and 15 years was 7%, 35%, and 75%, respectively. Patients with aden omas were more likely to have duodenal and ampullary adenomas. No correlati on was detected between adenoma development and the site of the adenomatous polyposis coli mutation. Conclusions Adenomas are frequently found in the ileal pouch of patients af ter restorative proctocolectomy for FAP. Regular endoscopic surveillance of the pouch is recommended at a frequency similar to that of upper gastroint estinal endoscopy.