Advertisement

Comparison of nonampullary duodenal adenomas in patients with familial adenomatous polyposis versus patients with sporadic adenomas

Published:August 13, 2016DOI:https://doi.org/10.1016/j.gie.2016.08.005

      Background and Aims

      Nonampullary duodenal adenomas are either sporadic or associated with a hereditary syndrome such as familial adenomatous polyposis (FAP). The aim of this study is to compare characteristics and outcomes of sporadic and FAP-associated duodenal adenomas.

      Methods

      We retrospectively collected clinical, endoscopic, and pathologic data in patients diagnosed with duodenal adenomas at our institution and included all available follow-up.

      Results

      Two hundred thirteen subjects were identified; 118 had FAP and 95 had sporadic adenomas. FAP subjects were more likely to have multifocal disease. Initial size was not significantly associated with dysplasia. Fourteen (12%) with FAP and 33 (35%) with sporadic adenomas underwent EMR. Among those subjects who did not undergo EMR or surgery, there was no difference between the FAP and sporadic groups with progression to new dysplasia or cancer. However, the FAP group was significantly more likely to have dysplasia at follow-up (P = .05). There was a significant difference in overall survival between the FAP and sporadic groups (log-rank test, P < .001). In the subgroup of patients aged 40 years old and older who did not undergo intervention, the FAP group had a shorter time to pathology progression compared with the similar sporadic subgroup. Range of time to progression to cancer was 3 to 161 months.

      Conclusions

      FAP subjects were more likely to be younger and have multifocal disease. Progression of pathology was more likely in the older FAP group compared with the sporadic group. Time to progression to cancer was widely variable and, therefore, unpredictable.

      Abbreviations:

      FAP (familial adenomatous polyposis), OS (overall survival)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bulow S.
        • Bjork J.
        • Christensen I.J.
        • et al.
        Duodenal adenomatosis in familial adenomatous polyposis.
        Gut. 2004; 53: 381-386
        • Heiskanen I.
        • Kellokumpu I.
        • Jarvinen H.
        Management of duodenal adenomas in 98 patients with familial adenomatous polyposis.
        Endoscopy. 1999; 31: 412-416
        • Jagelman D.G.
        • DeCosse J.J.
        • Bussey H.J.
        Upper gastrointestinal cancer in familial adenomatous polyposis.
        Lancet. 1988; 1: 1149-1151
        • Groves C.J.
        • Saunders B.P.
        • Spigelman A.D.
        • et al.
        Duodenal cancer in patients with familial adenomatous polyposis (FAP): results of a 10 year prospective study.
        Gut. 2002; 50: 636-641
        • Bulow S.
        Results of national registration of familial adenomatous polyposis.
        Gut. 2003; 52: 742-746
        • Johnson M.D.
        • Mackey R.
        • Brown N.
        • et al.
        Outcome based on management for duodenal adenomas: sporadic versus familial disease.
        J Gastrointest Surg. 2010; 14: 229-235
        • Farnell M.B.
        • Sakorafas G.H.
        • Sarr M.G.
        • et al.
        Villous tumors of the duodenum: reappraisal of local vs. extended resection.
        J Gastrointest Surg. 2000; 4 (discussion 2-3): 13-21
        • Kaplan E.L.
        • Meier P.
        Nonparametric estimation from incomplete observations.
        J Am Stat Assoc. 1958; 53: 457-481
        • Mantel N.
        Evaluation of survival data and two new rank order statistics arising in its consideration.
        Cancer Chemother Rep. 1966; 50: 163-170
        • Duffy S.W.
        • Nagtegaal I.D.
        • Wallis M.
        • et al.
        Correcting for lead time and length bias in estimating the effect of screen detection on cancer survival.
        Am J Epidemiol. 2008; 168: 98-104
        • Venables W.
        • Ripley B.
        Modern applied statistics with S-plus.
        3rd ed. Springer, New York1999
        • Sharaiha R.Z.
        • Cohen M.S.
        • Reimers L.
        • et al.
        Sporadic duodenal adenoma and association with colorectal neoplasia: a case-control study.
        Dig Dis Sci. 2014; 59: 2523-2528
        • Genta R.M.
        • Hurrell J.M.
        • Sonnenberg A.
        Duodenal adenomas coincide with colorectal neoplasia.
        Dig Dis Sci. 2014; 59: 2249-2254