BACKGROUND: The prevalence of duodenal carcinoma is much higher in familial adenomatous polyposis (FAP) than in the background population, and duodenal adenomatosis is found in most polyposis patients. AIMS: To describe the long term natural history of duodenal adenomatosis in FAP and evaluate if cancer prophylactic surveillance of the duodenum is indicated. METHODS: A prospective five nation study was carried out in the Nordic countries and the Netherlands. PATIENTS: A total of 368 patients were examined by gastroduodenoscopy at two year intervals during the period 1990-2001. RESULTS: At the first endoscopy, 238 (65%) patients had duodenal adenomas at a median age of 38 years. Median follow up was 7.6 years. The cumulative incidence of adenomatosis at age 70 years was 90% (95% confidence interval (CI) 79-100%), and of Spigelman stage IV 52% (95% CI 28-76%). The probability of an advanced Spigelman score increased during the study period (p<0.0001) due to an increasing number and size of adenomas. Two patients had asymptomatic duodenal carcinoma at their first endoscopy while four developed carcinoma during the study at a median age of 52 years (range 26-58). The cumulative incidence rate of cancer was 4.5% at age 57 years (95% CI 0.1-8.9%) and the risk was higher in patients with Spigelman stage IV at their first endoscopy than in those with stages 0-III (p<0.01). CONCLUSIONS: The natural course of duodenal adenomatosis has now been described in detail. The high incidence and increasing severity of duodenal adenomatosis with age justifies prophylactic examination, and a programme is presented for upper gastrointestinal endoscopic surveillance.
BACKGROUND: The prevalence of duodenal carcinoma is much higher in familial adenomatous polyposis (FAP) than in the background population, and duodenal adenomatosis is found in most polyposispatients. AIMS: To describe the long term natural history of duodenal adenomatosis in FAP and evaluate if cancer prophylactic surveillance of the duodenum is indicated. METHODS: A prospective five nation study was carried out in the Nordic countries and the Netherlands. PATIENTS: A total of 368 patients were examined by gastroduodenoscopy at two year intervals during the period 1990-2001. RESULTS: At the first endoscopy, 238 (65%) patients had duodenal adenomas at a median age of 38 years. Median follow up was 7.6 years. The cumulative incidence of adenomatosis at age 70 years was 90% (95% confidence interval (CI) 79-100%), and of Spigelman stage IV 52% (95% CI 28-76%). The probability of an advanced Spigelman score increased during the study period (p<0.0001) due to an increasing number and size of adenomas. Two patients had asymptomatic duodenal carcinoma at their first endoscopy while four developed carcinoma during the study at a median age of 52 years (range 26-58). The cumulative incidence rate of cancer was 4.5% at age 57 years (95% CI 0.1-8.9%) and the risk was higher in patients with Spigelman stage IV at their first endoscopy than in those with stages 0-III (p<0.01). CONCLUSIONS: The natural course of duodenal adenomatosis has now been described in detail. The high incidence and increasing severity of duodenal adenomatosis with age justifies prophylactic examination, and a programme is presented for upper gastrointestinal endoscopic surveillance.
Authors: J M Church; E McGannon; S Hull-Boiner; M V Sivak; R Van Stolk; D G Jagelman; V W Fazio; J R Oakley; I C Lavery; J W Milsom Journal: Dis Colon Rectum Date: 1992-12 Impact factor: 4.585
Authors: Christopher Groves; Hanan Lamlum; Michael Crabtree; Jill Williamson; Claire Taylor; Sylvia Bass; Darren Cuthbert-Heavens; Shirley Hodgson; Robin Phillips; Ian Tomlinson Journal: Am J Pathol Date: 2002-06 Impact factor: 4.307
Authors: M Nielsen; J W Poley; S Verhoef; M van Puijenbroek; M M Weiss; G T Burger; C J Dommering; H F A Vasen; E J Kuipers; A Wagner; H Morreau; F J Hes Journal: J Clin Pathol Date: 2006-08-30 Impact factor: 3.411
Authors: Clara Esteban-Jurado; Pilar Garre; Maria Vila; Juan José Lozano; Anna Pristoupilova; Sergi Beltrán; Anna Abulí; Jenifer Muñoz; Francesc Balaguer; Teresa Ocaña; Antoni Castells; Josep M Piqué; Angel Carracedo; Clara Ruiz-Ponte; Xavier Bessa; Montserrat Andreu; Luis Bujanda; Trinidad Caldés; Sergi Castellví-Bel Journal: World J Gastroenterol Date: 2014-02-28 Impact factor: 5.742