Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
J Gastroenterol Hepatol. 2023 Sep;38(9):1592-1597. doi: 10.1111/jgh.16281. Epub 2023 Jul 9.
Multiple duodenal polyposis associated with familial adenomatous polyposis (FAP) is a high risk of duodenal cancer development. We evaluated the feasibility of intensive endoscopic resection that is a comprehensive treatment strategy combining multiple kinds of endoscopic treatments.
This is a retrospective observational study. From January 2012 to July 2022, a total of 28 consecutive patients in FAP who underwent endoscopic resection for multiple duodenal polyposis more than twice were included. Various endoscopic treatments, such as cold polypectomy (CP), endoscopic mucosal resection (EMR), underwater EMR (UEMR), endoscopic submucosal dissection (ESD), and endoscopic papillectomy (EP), were applied depending on lesions size and location. We evaluated individual information from patients' medical records, including patient characteristics, lesion characteristics, details of endoscopic treatment, pathologic findings, and Spigelman index (SI). We compared the differences in the number of treatments and observation periods with and without SI decrease.
A total of 1040 lesions were removed by 138 sessions of endoscopic resections. The median follow-up period was 3.2 years. At the beginning of the endoscopic intervention, median SI was 9 (6-11) and the proportion of Spigelman stage (SS) IV was 61%. Repeated endoscopic treatments finally reduced SI in 26 patients (93%), and the proportion of SS IV significantly decreased to 13% with every endoscopic treatment. The mean SI change was -4.2 points per year (95% confidence interval: -0.6 to -5.9). There were no patients required surgical duodenectomy during the follow-up period.
Intensive resection has a potential of downstaging duodenal lesions associated with FAP.
家族性腺瘤性息肉病（FAP）相关的多发性十二指肠息肉是十二指肠癌发展的高风险因素。我们评估了强化内镜切除术的可行性，这是一种结合多种内镜治疗的综合治疗策略。
这是一项回顾性观察性研究。2012 年 1 月至 2022 年 7 月，共纳入 28 例 FAP 患者，这些患者因多发性十二指肠息肉接受了两次以上的内镜切除术。根据病变大小和位置，采用冷息肉切除术（CP）、内镜黏膜切除术（EMR）、水下 EMR（UEMR）、内镜黏膜下剥离术（ESD）和内镜乳头切除术（EP）等各种内镜治疗方法。我们从患者病历中评估了个体信息，包括患者特征、病变特征、内镜治疗细节、病理发现和 Spigelman 指数（SI）。我们比较了 SI 降低前后治疗次数和观察期的差异。
共通过 138 次内镜切除去除了 1040 个病变。中位随访期为 3.2 年。在开始内镜干预时，中位 SI 为 9（6-11），Spigelman 分期（SS）IV 比例为 61%。重复的内镜治疗最终使 26 例患者（93%）的 SI 降低，且每一次内镜治疗后 SS IV 的比例显著下降至 13%。SI 平均每年变化-4.2 分（95%置信区间：-0.6 至-5.9）。在随访期间，没有患者需要接受手术性十二指肠切除术。
强化切除可能使 FAP 相关的十二指肠病变降级。
