Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Gastroenterology, Ewha Womans University Medical Center, Seoul, Korea.
Surg Endosc. 2022 Feb;36(2):1310-1319. doi: 10.1007/s00464-021-08406-0. Epub 2021 Mar 11.
Although upper gastrointestinal (GI) neoplasms are not rare in patients with familial adenomatous polyposis (FAP), few studies have focused on them and the long-term outcomes of their treatment by endoscopy. Therefore, we aimed to investigate the prevalence and endoscopic treatment outcomes of upper GI neoplasms in patients with FAP.
Among 215 patients diagnosed with FAP between January 1991 and December 2019, 208 who underwent esophagogastroduodenoscopy were eligible. The clinical features and endoscopic treatment outcomes of upper GI neoplasms were retrospectively investigated and analyzed.
Among the enrolled patients, 113 (54.3%) had one or more upper GI neoplasms: gastric adenoma (n = 34), gastric cancer (n = 7), nonampullary duodenal adenoma (n = 86), and ampullary adenoma (n = 53). Among patients with gastric neoplasms (n = 37), 24 (64.9%) underwent treatment (endoscopic treatment: 22, surgery: 2). No tumor-related mortality occurred during median follow-up of 106 months (interquartile range [IQR] 63-174). Endoscopic treatment was performed in 47 (54.7%) of 86 patients with nonampullary duodenal adenoma and in 32 (60.4%) of 53 patients with ampullary adenoma. No patient underwent surgery for duodenal neoplasms, and no tumor-related mortality occurred during median follow-up of 88 months (IQR 42-145). The proportion of patients with increased Spigelman stage at 2 years after the initial diagnosis or treatment was significantly higher in untreated group than in the group treated for duodenal neoplasms (27.3% vs. 0.0%, p = 0.001).
Endoscopic surveillance in FAP patients is important for the detection and treatment of upper GI neoplasms in early stage. In particular, endoscopic therapy for duodenal neoplasms can reduce the severity of duodenal polyposis.
虽然家族性腺瘤性息肉病（FAP）患者中并不罕见上消化道（GI）肿瘤，但很少有研究关注它们以及内镜治疗的长期结果。因此，我们旨在研究 FAP 患者中 GI 肿瘤的患病率和内镜治疗结果。
在 1991 年 1 月至 2019 年 12 月期间诊断为 FAP 的 215 名患者中，有 208 名接受了食管胃十二指肠镜检查，符合入选条件。回顾性调查和分析了上 GI 肿瘤的临床特征和内镜治疗结果。
在纳入的患者中，有 113 名（54.3%）有一个或多个上 GI 肿瘤：胃腺瘤（n=34）、胃癌（n=7）、非壶腹十二指肠腺瘤（n=86）和壶腹腺瘤（n=53）。在胃肿瘤患者中（n=37），24 名（64.9%）接受了治疗（内镜治疗：22 例，手术：2 例）。在中位随访 106 个月（IQR 63-174）期间，无肿瘤相关死亡。86 例非壶腹十二指肠腺瘤患者中有 47 例（54.7%）行内镜治疗，53 例壶腹腺瘤患者中有 32 例（60.4%）行内镜治疗。无患者因十二指肠肿瘤行手术治疗，在中位随访 88 个月（IQR 42-145）期间，无肿瘤相关死亡。在初始诊断或治疗后 2 年未治疗组中，Spigelman 分期增加的患者比例明显高于接受十二指肠肿瘤治疗组（27.3%比 0.0%，p=0.001）。
FAP 患者的内镜监测对于早期发现和治疗上 GI 肿瘤很重要。特别是，内镜治疗十二指肠肿瘤可以减轻十二指肠息肉病的严重程度。
