Background and Aims

Duodenal polyposis and cancer have become a key issue for patients with familial adenomatous polyposis (FAP) and MUTYH-associated polyposis (MAP). Almost all patients with FAP will develop duodenal adenomas, and 5% will develop cancer. The incidence of duodenal adenomas in MAP appears to be lower than in FAP, but the limited available data suggest a comparable increase in the relative risk and lifetime risk of duodenal cancer. Current surveillance recommendations, however, are the same for FAP and MAP, using the Spigelman score (incorporating polyp number, size, dysplasia, and histology) for risk stratification and determination of surveillance intervals. Previous studies have demonstrated a benefit of enhanced detection rates of adenomas by use of chromoendoscopy both in sporadic colorectal disease and in groups at high risk of colorectal cancer. We aimed to assess the effect of chromoendoscopy on duodenal adenoma detection, to determine the impact on Spigelman stage and to compare this in individuals with known pathogenic mutations in order to determine the difference in duodenal involvement between MAP and FAP.

Methods

A prospective study examined the impact of chromoendoscopy on the assessment of the duodenum in 51 consecutive patients with MAP and FAP in 2 academic centers in the United Kingdom (University Hospital Llandough, Cardiff, and St Mark’s Hospital, London) from 2011 to 2014.

Results

Enhanced adenoma detection of 3 times the number of adenomas after chromoendoscopy was demonstrated in both MAP (P = .013) and FAP (P = .002), but did not affect adenoma size. In both conditions, there was a significant increase in Spigelman stage after chromoendoscopy compared with endoscopy without dye spray. Spigelman scores and overall adenoma detection was significantly lower in MAP compared with FAP.

Conclusions

Chromoendoscopy improved the diagnostic yield of anomas in MAP and FAP 3-fold, and in both MAP and FAP this resulted in a clinically significant upstaging in Spigelman score. Further studies are required to determine the impact of improved adenoma detection on the management and outcome of duodenal polyposis.

中文翻译：

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内窥镜检查对MUTYH相关性息肉病和家族性腺瘤性息肉病患者十二指肠监测的影响

背景和目标

对于家族性腺瘤性息肉病（FAP）和MUTYH相关性息肉病（MAP）的患者，十二指肠息肉病和癌症已成为关键问题。几乎所有患有FAP的患者都会发展十二指肠腺瘤，而5％会发展为癌症。MAP中十二指肠腺瘤的发生率似乎低于FAP，但有限的可用数据表明十二指肠癌的相对风险和终生风险有相当的增加。但是，当前的监测建议与FAP和MAP相同，使用Spigelman评分（结合息肉数量，大小，发育异常和组织学）进行风险分层和确定监测间隔。先前的研究表明，在散发性结直肠疾病和高结直肠癌高危人群中，使用色谱内窥镜可以提高腺瘤的检出率。

方法

一项前瞻性研究检查了2011年至2014年英国2个学术中心（共兰德大学兰迪夫分校和伦敦圣马可医院）连续51例MAP和FAP患者中十二指肠对十二指肠评估的影响。

结果

MAP（P  = .013）和FAP（P  = .002）均证实，在色内镜检查后，腺瘤的检出率是腺瘤数目的3倍，但并不影响腺瘤的大小。在两种情况下，与不使用染料喷雾的内窥镜检查相比，在色谱内窥镜检查后，Spigelman分期显着增加。与FAP相比，MAP的Spigelman评分和总体腺瘤检出率显着降低。

结论

染色体内窥镜检查将MAP和FAP异常的诊断率提高了3倍，而在MAP和FAP中，这都使Spigelman评分在临床上显着提高。需要进一步的研究来确定改善的腺瘤检测对十二指肠息肉病的治疗和预后的影响。