Duodenal Disease Rates Increase in Patients With Prophylactic Colectomy
WESTPORT, CT (Reuters Health) Dec 07 -
The lifetime risk of severe duodenal lesions in patients with familial adenomatous polyposis (FAP) is nearly 100% once patients have undergone prophylactic colectomy, Swedish investigators report. Duodenal adenomas were present in 134 of 180 patients who had undergone the procedure for esophagogastroduodenoscopy at any time between 1982 and 1999, Dr. Jan Björk, of Karolinska Hospital in Stockholm, and associates found.
Fourteen patients went on to develop stage-IV adenomas in the region of the ampulla of Vater approximately 7 years after a normal duodenum had been diagnosed. Three patients previously diagnosed with stage-IV periampullary adenoma developed adenocarcinoma at this site, as did two patients who had less severe periampullary adenomatosis.
According to the Swedish team's report in the November issue of Gastroenterology, all adenocarcinomas were diagnosed because of symptoms. Dr. Björk's group stresses the importance of endoscopic screening that includes biopsies of the periampullary region. The investigators add, "stage-IV periampullary adenomas must be taken seriously," with prophylactic surgery considered for severe cases.
Nine of 10 families with stage-IV periampullary adenomas had mutations of the APC gene. Therefore, the researchers suggest, genetic screening may be helpful in predicting the outcome of duodenal adenomatosis in individuals from FAP families and to guide future surveillance and treatment.
Dr. Carol Burke, of the Cleveland Clinic Foundation in Ohio, suggests in a commentary that side-viewing endoscopy in addition to that conducted with forward-viewing instruments only may allow the detection of these cancers at screening.
However, she acknowledges that "failure to detect these adenocarcinomas during endoscopic surveillance may indicate the rapid progression of disease in some patients or our inability to discern early periampullary carcinoma endoscopically."
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