[Adenomatous lesions of the papilla in familial adenomatous rectocolic polyposis. Value of duodenoscopy].

When compared to the general population, individuals with Gardner's syndrome may have a 100- to 200-fold increased risk of developing periampullary carcinoma. This prospective work was undertaken in order to study the endoscopic aspects and to perform biopsies of the papilla in 9 patients (7 males, 2 females, aged 18-65 years) with familial polyposis coli or Gardner syndrome. In 4 cases the papilla was endoscopically grossly polypoid and biopsies showed adenomatous lesions. In 5 cases, the papilla appeared endoscopically normal; in 2 cases, the papilla appeared endoscopically normal; in 2 of these cases biopsies showed adenomatous proliferation; in the 3 other cases, the biopsies were normal. In 5 cases, there were adenomatous duodenal lesions outside the papilla. These results suggest that: a) adenomatous lesions of the papilla are frequent in familial polyposis coli and Gardner's syndrome; b) the endoscopic gross aspect of the papilla may be normal even when there are adenomatous lesions; c) adenomatous lesions of the papilla may be associated or not with adenomatous lesions of the 2nd duodenum; d) as the natural history of these lesions is not known and because of the risk of cancer of Vater's ampulla, it seems reasonable to perform routine duodenoscopies with biopsies in order to ensure early diagnosis of cancer.