Iaquinto Gaetano, Fornasarig Mara, Quaia Michele, Giardullo Nicola, D'Onofrio Vittorio, Iaquinto Salvatore, Di Bella Simone, Cannizzaro Renato
Avellino, Aviano, Italy.
Gastrointest Endosc. 2008 Jan;67(1):61-7. doi: 10.1016/j.gie.2007.07.048.
Duodenal cancer and ampullary cancer are major causes of death after a prophylactic colectomy in patients with familial adenomatous polyposis (FAP). Forward-viewing endoscopy and side-viewing endoscopy are recommended in patients with FAP for surveillance of periampullary and duodenal polyposis. The study of polyps distal to the duodenum in FAP is limited. A capsule endoscopy (CE) allows visualization of the mucosa of the entire small bowel.
The objective was to detect whether CE has clinical value or any utility for the surveillance of small-bowel polyps in patients with FAP and to evaluate whether there are genotypic factors that predict which patients are at a lower risk of small-bowel polyps.
Two Italian tertiary-referral centers.
Twenty-three patients with FAP who presented for a CE.
Patients with FAP were examined by CE to assess the location, size, and number of small-bowel polyps. Patient age at CE, sex, years of observation after surgery, type of surgery, duodenal adenomas, and colorectal cancer at surgery were analyzed. All patients were selected for mutation analysis, and the germline adenomatous polyposis coli (APC) gene mutation was detected.
Eleven of 23 patients with FAP had duodenal polyps. During CE, jejunal-ileal polyps were detected in 7 of 23 FAPs, with a total number of 15 polyps in the ileum. The presence of duodenal adenomas was the only clinical feature predictive of small-bowel polyps. Identification of the ampulla of Vater was not achieved with CE; duodenal polyps were only seen in 4 of 11 patients identified endoscopically, with an underestimation of polyp numbers. APC mutations between codons 499 and 805 were associated with the absence of small-bowel polyps.
CE is useful and safe for the surveillance of jejunal-ileal polyps in selected patients with FAP. CE is not useful in the surveillance of the duodenum where the majority of small-bowel cancers occur.
十二指肠癌和壶腹癌是家族性腺瘤性息肉病（FAP）患者预防性结肠切除术后的主要死亡原因。推荐对FAP患者进行前视内镜检查和侧视内镜检查，以监测壶腹周围和十二指肠息肉病。FAP患者十二指肠远端息肉的研究有限。胶囊内镜（CE）可观察整个小肠黏膜。
目的是检测CE对FAP患者小肠息肉监测是否具有临床价值或任何作用，并评估是否存在预测哪些患者小肠息肉风险较低的基因型因素。
两个意大利三级转诊中心。
23例接受CE检查的FAP患者。
对FAP患者进行CE检查，以评估小肠息肉的位置、大小和数量。分析患者接受CE检查时的年龄、性别、术后观察年限、手术类型、十二指肠腺瘤和手术时的结直肠癌情况。所有患者均入选进行突变分析，并检测胚系腺瘤性息肉病（APC）基因突变。
23例FAP患者中有11例患有十二指肠息肉。在CE检查期间，23例FAP患者中有7例检测到空肠-回肠息肉，回肠息肉总数为15个。十二指肠腺瘤的存在是预测小肠息肉的唯一临床特征。CE未成功识别十二指肠乳头；在内镜检查确诊的11例患者中，仅4例发现十二指肠息肉，息肉数量被低估。密码子499至805之间的APC突变与无小肠息肉相关。
CE对选定的FAP患者监测空肠-回肠息肉有用且安全。CE对大多数小肠癌发生部位的十二指肠监测无用。
