Laurie Barclay, MD NEW YORK (MedscapeWire) May 17
Prospective screening with surveillance endoscopy in patients with familial adenomatous polyposis (FAP) has thus far been ineffective in preventing duodenal cancer, according to results of a 10-year follow-up program published in the May issue of Gut. “Surveillance for duodenal adenocarcinoma and subsequent early referral for curative surgery has not been effective,” write C. J. Groves, from St. Mark’s Hospital in Harrow, England, and colleagues. “More comprehensive endoscopic surveillance of high-risk (stage III and IV) patients is needed in an attempt to avoid underestimating the severity of duodenal polyposis, and to evaluate the role of endoscopic therapy in preventing advanced disease.” Of 114 patients with FAP who received prospective screening, 6 developed duodenal adenocarcinoma, including 4 of 11 patients who originally had Spigelman stage IV disease, 1 of 41 patients with stage III, and 1 of 44 with stage II. In the stage IV group with advanced duodenal polyposis, risk of developing cancer was 36% compared with 2% for patients with stage III or stage II disease.
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