Lemos Garcia Joana, Rosa Isadora, Pereira da Silva João, Lage Pedro, Claro Isabel
Gastroenterology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., Lisboa, Portugal.
Familial Risk Clinic, Instituto Português de Oncologia de Lisboa Francisco Gentil E.P.E., Lisboa, Portugal.
GE Port J Gastroenterol. 2022 Nov 29;30(6):430-436. doi: 10.1159/000527209. eCollection 2023 Dec.
Over 90% of the patients with familial adenomatous polyposis (FAP) will develop duodenal adenomas.
The aim of this study was to evaluate the effectiveness and safety of endoscopic excision of large duodenal adenomas in FAP patients.
All FAP patients from a familial risk clinic submitted to endoscopic therapy for duodenal adenomas ≥10 mm between January 2010 and February 2021 were included.
From 151 FAP families, 22 patients (50 lesions) were included: 54.5% female; median follow-up 8.5 (IQR: 5.8-12.3) years after the first endoscopy. First therapeutic endoscopy occurred at a median age of 41.0 years (IQR: 33.0-58.2). Repeat therapeutic endoscopy was required in 54.5% of patients. Median size of the largest adenoma was 15 mm (IQR: 10-18 mm); resection was piecemeal in 63.1% and en bloc in the remaining. In 2 cases, the resection was incomplete (fibrosis due to previous resection and difficult positioning). Complications occurred in 6.3% of the resected lesions (4 patients): 2 immediate (bleeding, perforation); 4 in the first week (1 bleeding, 2 mild pancreatitis, 1 perforation requiring surgery; the latter two after ampullectomy). Histology revealed low-grade dysplasia adenomas in 90.1%; no adenocarcinomas were found. One patient with Spigelman stage IV disease not amenable to endoscopic control underwent elective duodenopancreatectomy (without duodenal cancer).
Endoscopic surveillance and treatment of duodenal adenomas in FAP patients was safe and effective in the prevention of duodenal cancer.
超过90%的家族性腺瘤性息肉病（FAP）患者会发生十二指肠腺瘤。
本研究旨在评估内镜切除FAP患者大型十二指肠腺瘤的有效性和安全性。
纳入2010年1月至2021年2月期间在家族风险诊所接受内镜治疗的所有十二指肠腺瘤≥10 mm的FAP患者。
来自151个FAP家族的22例患者（50个病变）被纳入研究：女性占54.5%；首次内镜检查后的中位随访时间为8.5年（四分位间距：5.8 - 12.3年）。首次治疗性内镜检查的中位年龄为41.0岁（四分位间距：33.0 - 58.2岁）。54.5%的患者需要重复治疗性内镜检查。最大腺瘤的中位大小为15 mm（四分位间距：10 - 18 mm）；63.1%的切除为分块切除，其余为整块切除。2例切除不完全（因先前切除导致纤维化和定位困难）。6.3%的切除病变（4例患者）发生并发症：2例为即刻并发症（出血、穿孔）；4例在第一周发生（1例出血、2例轻度胰腺炎、1例穿孔需手术治疗；后两例在壶腹切除术后）。组织学检查显示90.1%为低级别异型增生腺瘤；未发现腺癌。1例Spigelman IV期疾病且无法通过内镜控制的患者接受了择期十二指肠胰切除术（无十二指肠癌）。
FAP患者十二指肠腺瘤的内镜监测和治疗在预防十二指肠癌方面是安全有效的。
