Upper gastrointestinal neoplasia in familial adenomatous polyposis: prevalence, endoscopic features and management

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art_CAMPOS_Upper_gastrointestinal_neoplasia_in_familial_adenomatous_polyposis_prevalence_2019.PDF (819.88 KB)
Citações na Scopus
14
Tipo de produção
article
Data de publicação
2019
DOI
Scopus
Web of Science
Título da Revista
ISSN da Revista
Título do Volume
Editora
PIONEER BIOSCIENCE PUBL CO
Autores
Citação
JOURNAL OF GASTROINTESTINAL ONCOLOGY, v.10, n.4, p.734-744, 2019
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Background: To evaluate the prevalence of upper gastrointestinal (GI) polyps in familial adenomatous polyposis (FAP), and to discuss current therapeutic recommendations. Methods: Clinical, endoscopic, histological and treatment data were retrieved from charts of 102 patients [1958-2016]. Duodenal adenomatosis was classified according to Spigelman stages. Results: this series comprised 59 women (57.8%) and 43 men (42.1%) with a median age of 32.3 years. Patients underwent 184 endoscopic procedures, the first at a median age of 35.9 years (range, 13-75 years). Fundic gastric polyps (n=31; 30.4%) prevailed in the stomach. While only 5 adenomas were found in the stomach, 33 patients (32.4%) presented duodenal ones. Advanced lesions (n=13; 12.7%) were detected in the stomach (n=2) and duodenum (n=11). During follow-up, Spigelman stages improved in 6 (12.2%) patients, remained unchanged in 25 (51.0%) and worsened in 18 (36.7%). Carcinomas were diagnosed in the stomach and duodenum (4 lesions each, 3.9%), at median ages of 50.2 and 55.0 years, respectively. Advanced lesions and carcinomas were managed through local or surgical resections. Severe complications occurred in only 2 patients (one death). Enteroscopy in 21 patients revealed jejunal adenomas in 12, 11 of whom also presented duodenal adenomas. Conclusions: There is a high prevalence of upper GI adenomas and cancer in FAP. There were diagnosed fundic gastric polyps (30.4%), duodenal (32.4%) and jejunal adenomas (11.8%), respectively. One third of duodenal polyps progressed slowly throughout the study. The rates of advanced gastroduodenal lesions (12.7%) and cancer (7.8%) raise the need for continuous surveillance during follow-up.
Palavras-chave
Familial adenomatous polyposis (FAP), adenomas, duodenum, small bowel, surveillance
URI
https://observatorio.fm.usp.br/handle/OPI/33252
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Coleções
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - HC/ICESP
Artigos e Materiais de Revistas Científicas - LIM/24
Artigos e Materiais de Revistas Científicas - ODS/03