Prevention and management of duodenal polyps in familial adenomatous polyposis

L. A A Brosens, J. J. Keller, G. J A Offerhaus, Michael S Goggins, Francis M Giardiello

Research output: Contribution to journalArticle

Abstract

FAP is characterised by innumerable adenomatous polyps throughout the colorectum and inevitable development of colorectal carcinoma usually by the fifth decade of life, if colectomy is not performed. Duodenal adenomas are found in 30-70% of FAP patients. The lifetime risk of duodenal adenoma development is virtually 100%. FAP patients have a 100-330-fold higher risk of developing duodenal cancer compared with the general population and an absolute lifetime risk of about 5%. No clear genotype-phenotype correlation exists, although mutations in the 3′ end of the APC gene (exon 15) appear to cause more severe duodenal manifestations. First screening for upper gastrointestinal adenoma is recommended at age 25-30 years. After baseline endoscopy, screening for duodenal polyposis is recommended as per Spigelman stage (see table 3). Recurrence of duodenal lesions after local endoscopic or surgical excision is common. Pancreaticoduodenectomy is the appropriate treatment for Spigelman stage IV duodenal polyposis and can be considered for stage III. Results of chemoprevention/regression studies for duodenal adenomas are equivocal or disappointing.

Original languageEnglish (US)
Pages (from-to)1034-1043
Number of pages10
JournalGut
Volume54
Issue number7
DOIs
StatePublished - Jul 2005

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Adenomatous Polyposis Coli
Polyps
Adenoma
Duodenal Neoplasms
APC Genes
Adenomatous Polyps
Pancreaticoduodenectomy
Colectomy
Chemoprevention
Genetic Association Studies
Endoscopy
Colorectal Neoplasms
Exons
Recurrence
Mutation
Population
Therapeutics

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Prevention and management of duodenal polyps in familial adenomatous polyposis. / Brosens, L. A A; Keller, J. J.; Offerhaus, G. J A; Goggins, Michael S; Giardiello, Francis M.

In: Gut, Vol. 54, No. 7, 07.2005, p. 1034-1043.

Research output: Contribution to journalArticle

Brosens, L. A A ; Keller, J. J. ; Offerhaus, G. J A ; Goggins, Michael S ; Giardiello, Francis M. / Prevention and management of duodenal polyps in familial adenomatous polyposis. In: Gut. 2005 ; Vol. 54, No. 7. pp. 1034-1043.
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