INTRODUCTION Fundic gland polyps (FGPs) are commonly found in patients with familial adenomatous polyposis (FAP) and are considered benign. Biopsies are not routinely performed, and conventional forceps may be time-consuming and/or yield nonrepresentative histology. The purpose of this study was to evaluate the role of a novel endoscopic polypectomy surveillance (EPS), a large volume cold-snare polypectomy technique of random FGPs, in the incidence of dysplasia and gastric cancer (GC) in FAP. METHODS This is a retrospective longitudinal cohort of patients with FAP referred to a tertiary care center for duodenal adenoma surveillance and who underwent EPS of FGPs between 2001 and 2019. Demographic, endoscopic, and clinicopathologic information was reviewed. RESULTS Thirty-five patients with FAP were identified at initial endoscopy by the mean age of 43.4 years (±12.8). One hundred thirteen surveillance endoscopies were performed in total using EPS. Dysplasia of FGPs was present on initial esophagogastroduodenoscopy in 7 patients (20%), and 13 additional patients (46.4%) progressed to low-grade dysplasia. Three patients (15%) who subsequently had progression to GC were found to have signet ring cell cancer within the foci of FGPs through EPS. One patient presented as metastatic GC. Progression from nondysplastic FGP to low-grade dysplasia occurred over 63 months (±46.3) with further progression to GC over 34 months (±8.5). Endoscopic risk factors for cancer were polyps >10 mm in size ( P < 0.001) and carpeting of polyps ( P < 0.001). The 5-year cumulative incidence of developing dysplasia was 35.7%. DISCUSSION We identified that the incidence of dysplasia and GC is higher than previously reported in patients with FAP. Our study used a novel EPS technique and was able to identify GC within the foci of FGPs. Upper endoscopic guidelines should include a more rigorous sampling method for FGPs, such as EPS, to optimize early detection of dysplasia and GC.

中文翻译：

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家族性腺瘤性息肉病胃底腺息肉的新型内窥镜息肉切除术监测技术可以提高不典型增生和胃癌的早期检测。

引言 胃底腺息肉 (FGP) 常见于家族性腺瘤性息肉病 (FAP) 患者，被认为是良性的。活检不是常规进行的，传统的镊子可能很耗时和/或产生不具代表性的组织学。本研究的目的是评估新型内窥镜息肉切除术监测 (EPS) 的作用，这是一种随机 FGP 的大体积冷圈套息肉切除术技术，在 FAP 不典型增生和胃癌 (GC) 的发生率中的作用。方法 这是一个回顾性纵向队列，纳入了在 2001 年至 2019 年间转诊至三级医疗中心进行十二指肠腺瘤监测并接受了 FGP EPS 治疗的 FAP 患者。对人口统计学、内窥镜和临床病理学信息进行了审查。结果 35 名 FAP 患者在初次内镜检查时被确诊，平均年龄为 43.4 岁 (±12.8)。使用 EPS 总共进行了 113 次监视内窥镜检查。7 名患者 (20%) 在初次食管胃十二指肠镜检查时发现 FGP 发育不良，另外 13 名患者 (46.4%) 进展为低度发育不良。随后进展为 GC 的三名患者 (15%) 通过 EPS 被发现在 FGPs 病灶内患有印戒细胞癌。一名患者表现为转移性 GC。在 63 个月 (±46.3) 内从非发育不良 FGP 进展为低度发育不良，并在 34 个月内 (±8.5) 进一步进展为 GC。癌症的内窥镜危险因素是息肉>10 毫米 (P < 0.001) 和息肉铺展 (P < 0.001)。发生异型增生的 5 年累积发生率为 35.7%。讨论 我们发现在 FAP 患者中异型增生和 GC 的发生率高于之前报道的。我们的研究使用了一种新的 EPS 技术，并且能够在 FGP 的焦点内识别 GC。上部内窥镜指南应包括更严格的 FGP 采样方法，例如 EPS，以优化异型增生和 GC 的早期检测。