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.
Abbreviations:
APC (adenomatous polyposis coli), FAP (familial adenomatous polyposis), GC (gastric cancer), PPI (proton pump inhibitor)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 28, 2018
Accepted:
December 17,
2018
Received:
August 15,
2018
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact Dr Leone at [email protected]
Identification
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© 2019 by the American Society for Gastrointestinal Endoscopy
