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“High rate of recurrent adenomatosis during endoscopic surveillance after duodenectomy in patients with familial adenomatous polyposis”

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Abstract

Advanced duodenal adenomatosis in patients with familial adenomatous polyposis (FAP) is associated with a significant risk of duodenal carcinoma. Duodenectomy is sometimes indicated to prevent malignant transformation or to resect established carcinomas. Advanced recurrent adenomatosis and cancer formation in the neo-duodenum after duodenectomy in FAP have been reported. The aim of this study was to describe findings during endoscopic follow-up in a cohort of FAP patients after duodenectomy, to assess the indication and whether recommendations can be made for endoscopic surveillance. All FAP patients with a history of duodenectomy performed at a single tertiary referral centre between January 2000 and July 2011 were identified. Patient characteristics and postoperative upper endoscopic procedures were reviewed retrospectively. 19 patients, with a mean age of 49 years at the time of duodenectomy were identified. One patient was lost to follow-up. The majority of patients underwent prophylactic pancreas preserving duodenectomy (95 %). Mean duration of postoperative follow-up in 18 patients was 78 months with 4 postoperative endoscopies on average. An increase in neo-Spigelman stage was seen in 9 patients, after an average interval of 35 months. Overall, newly formed adenomas in the neo-duodenum were found in 14 of 18 patients (78 %), after a mean of 46 months after duodenectomy. Recurrent adenomas were mostly located in close proximity to the neo-papilla. This included advanced adenomas in 7 patients, warranting enteric re-resection in 2 patients. Continued intensive endoscopic surveillance is indicated after duodenectomy in FAP, especially of the area around the bilio- and pancreatico-enteric anastomoses.

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Acknowledgments

We are grateful for the help of Dr. S. M. de Castro in updating the list of candidate patients in the current study.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    Yasser A. Alderlieste, Barbara A. Bastiaansen, Elisabeth M. H. Mathus-Vliegen & Evelien Dekker

  2. Department of Surgery, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    Dirk J. Gouma

Authors
  1. Yasser A. Alderlieste
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  2. Barbara A. Bastiaansen
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  3. Elisabeth M. H. Mathus-Vliegen
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  4. Dirk J. Gouma
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  5. Evelien Dekker
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Correspondence to Yasser A. Alderlieste.

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Alderlieste, Y.A., Bastiaansen, B.A., Mathus-Vliegen, E.M.H. et al. “High rate of recurrent adenomatosis during endoscopic surveillance after duodenectomy in patients with familial adenomatous polyposis”. Familial Cancer 12, 699–706 (2013). https://doi.org/10.1007/s10689-013-9648-5

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  • DOI: https://doi.org/10.1007/s10689-013-9648-5

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