Pamela J Leone1, Gautam Mankaney2, Shashank Sarvapelli1, Suha Abushamma1, Rocio Lopez3, Michael Cruise4, Lisa LaGuardia5, Margaret O'Malley5, James M Church5, Matthew F Kalady5, Carol A Burke6. 1. Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA. 2. Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA. 3. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA. 4. Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA; Sanford R. Weiss MD Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, Ohio, USA. 5. Sanford R. Weiss MD Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, Ohio, USA; Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio, USA. 6. Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA; Sanford R. Weiss MD Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, Ohio, USA; Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
Abstract
BACKGROUND AND AIMS: Gastric cancer (GC) is a newly described cancer risk in Western patients with familial adenomatous polyposis (FAP). Little is known about clinical, endoscopic, and pathologic features associated with FAP-related GC. We compared these features in FAP patients with and without GC. METHODS: FAP patients were identified through the David G. Jagelman Inherited Colorectal Cancer Registries Cologene database. FAP patients with GC and randomly selected FAP patients without GC who had undergone at least 2 EGDs were analyzed. Demographic, clinical, endoscopic, and pathologic features were compared. RESULTS: Ten FAP patients with GC were identified, and 40 age-matched FAP control subjects were selected. No demographic differences were noted between patients and control subjects. All GC cases arose in the proximal stomach among gastric polyposis, with only 2 endoscopically visible. The prevalence of gastric polyposis was similar (100% vs 93%). Endoscopic features associated with GC included a carpeting of gastric polyps (100% vs 22.5%), solitary polyps >20 mm (100% vs 0%), and a polypoid mound of polyps (80% vs 0%; all P < .001). GC patients had a higher prevalence of gastric adenomas (30% vs 5%, P = .048) and polyps with high-grade dysplasia, including fundic gland polyps (50% vs 10%, P = .01) and pyloric gland adenomas (20% vs 0%, P = .037). CONCLUSIONS: We identified endoscopic features and advanced pathology present in the stomachs of Western patients with FAP who developed GC. Upper GI surveillance in FAP should include the stomach and awareness of features associated with GC. Optimal approaches to treatment of gastric polyposis and methods of identification of early GC precursors in FAP are needed.
BACKGROUND AND AIMS: Gastric cancer (GC) is a newly described cancer risk in Western patients with familial adenomatous polyposis (FAP). Little is known about clinical, endoscopic, and pathologic features associated with FAP-related GC. We compared these features in FAPpatients with and without GC. METHODS:FAPpatients were identified through the David G. Jagelman Inherited Colorectal Cancer Registries Cologene database. FAPpatients with GC and randomly selected FAPpatients without GC who had undergone at least 2 EGDs were analyzed. Demographic, clinical, endoscopic, and pathologic features were compared. RESULTS: Ten FAPpatients with GC were identified, and 40 age-matched FAP control subjects were selected. No demographic differences were noted between patients and control subjects. All GC cases arose in the proximal stomach among gastric polyposis, with only 2 endoscopically visible. The prevalence of gastric polyposis was similar (100% vs 93%). Endoscopic features associated with GC included a carpeting of gastric polyps (100% vs 22.5%), solitary polyps >20 mm (100% vs 0%), and a polypoid mound of polyps (80% vs 0%; all P < .001). GC patients had a higher prevalence of gastric adenomas (30% vs 5%, P = .048) and polyps with high-grade dysplasia, including fundic gland polyps (50% vs 10%, P = .01) and pyloric gland adenomas (20% vs 0%, P = .037). CONCLUSIONS: We identified endoscopic features and advanced pathology present in the stomachs of Western patients with FAP who developed GC. Upper GI surveillance in FAP should include the stomach and awareness of features associated with GC. Optimal approaches to treatment of gastric polyposis and methods of identification of early GC precursors in FAP are needed.
Authors: Isabel Martin; Victorine H Roos; Chukwuemeka Anele; Sarah-Jane Walton; Victoria Cuthill; Noriko Suzuki; Barbara A Bastiaansen; Susan K Clark; Alexander von Roon; Evelien Dekker; Andrew Latchford Journal: Endoscopy Date: 2020-11-05 Impact factor: 9.776