Background and Aims

Almost all patients with familial adenomatous polyposis (FAP) develop duodenal adenomas, with a 4% to 18% risk of progression into duodenal cancer. Prophylactic endoscopic resection of duodenal adenomas may prevent cancer and is considered safer than surgical alternatives; however, data are limited. Therefore, the aim of this study was to assess safety and effectiveness of endoscopic duodenal interventions in patients with FAP.

Methods

We performed a historical cohort study including patients with FAP who underwent an endoscopic duodenal intervention between 2002 and 2018. Safety was defined as adverse event rate per intervention and effectiveness as duodenal surgery–free and duodenal cancer–free survival. Change in Spigelman stage was assessed as a secondary outcome.

Results

In 68 endoscopy sessions, 139 duodenal polypectomies were performed in 49 patients (20 men; median age, 43). Twenty-nine patients (14 men; median age, 49) underwent a papillectomy. After polypectomy, 9 (13%) bleedings and 1 (2%) perforation occurred, all managed endoscopically. Six (21%) bleedings (endoscopically managed), 4 (14%) cases of pancreatitis, and 1 (3%) perforation (conservatively treated) occurred after papillectomy. Duodenal surgery–free survival was 74% at 89 months after polypectomy and 71% at 71 months after papillectomy; no duodenal cancers were observed. After a median of 18 months (interquartile range, 10-40; range, 3-121) after polypectomy, Spigelman stages were significantly lower (P < .01).

Conclusions

In our FAP patients, prophylactic duodenal polypectomies were relatively safe. Papillectomies showed substantial adverse events, suggesting its benefits and risk should be carefully weighted. Both were effective, however, because surgical interventions were limited and none developed duodenal cancer.

中文翻译：

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家族性腺瘤性息肉病患者十二指肠腺瘤的内镜处理。

背景和目标

几乎所有的家族性腺瘤性息肉病（FAP）患者都会发展为十二指肠腺瘤，罹患十二指肠癌的风险为4％至18％。十二指肠腺瘤的预防性内窥镜切除术可以预防癌症，并且被认为比外科手术更安全；但是，数据有限。因此，本研究的目的是评估内镜十二指肠干预对FAP患者的安全性和有效性。

方法

我们进行了一项历史性队列研究，包括2002年至2018年间接受内镜十二指肠干预的FAP患者。安全性定义为每次干预的不良事件发生率和有效性，即无十二指肠手术和无十二指肠癌的生存期。Spigelman分期的改变被认为是次要结果。

结果

在68次内镜检查中，对49例患者（20名男性；中位年龄为43岁）进行了139个十二指肠多切口检查。29例患者（14名男性；中位年龄49岁）接受了乳头状瘤切除术。息肉切除后，发生9例（13％）出血和1例（2％）穿孔，均通过内窥镜处理。乳头切除术后发生六次（21％）出血（内窥镜处理），4例（14％）胰腺炎和1例（3％）穿孔（保守治疗）。息肉切除术后89个月无十二指肠手术生存率，乳头切除术后71个月无生存率71％。没有观察到十二指肠癌。息肉切除术中位后18个月（四分位间距为10-40；范围为3-121），Spigelman分期显着降低（P < .01）。

结论

在我们的FAP患者中，预防性十二指肠多切影术相对安全。偏瘫患者显示出严重的不良事件，表明应仔细权衡其获益和风险。但是，这两种方法都是有效的，因为外科手术的干预很有限，而且都没有发展成十二指肠癌。