Endoscopic management of duodenal lesions in familial adenomatous polyposis: A tertiary referral center experience.

APC

Endoscopic surveillance and treatment of duodenal and ampullary lesions in genetically confirmed familial adenomatous polyposis

This retrospective study of prospectively collected data covers 233 genetically confirmed familial adenomatous polyposis patients followed by upper endoscopy in a referral centre between 2013 and 2023. A total of 862 endoscopies were performed and 208 duodenal lesions treated, cold snare polypectomy being the most frequent technique (41.9%). Histology showed low-grade dysplasia in 72.4% of lesions, high-grade dysplasia in 25.9% and adenocarcinoma in 1.7%. Forty-seven ampullary lesions were identified, managed by surveillance in 78.7% of cases and by papillectomy in 21.3%. The authors report that structured surveillance was associated with more lesions treated and a reduced rate of high-grade dysplasia.

Synthesis written by Geno'X. For the full original abstract, please refer to the source publication.

For the geneticist the value lies downstream of the molecular diagnosis: once polyposis is confirmed, benefit depends on the quality of the endoscopic programme, and this series provides useful figures for the clinic (1.7% adenocarcinoma among treated lesions, a fifth of ampullary lesions warranting papillectomy). The demonstration remains observational and single-centre in an expert setting: the association between structured surveillance and lower high-grade dysplasia is not proof of efficacy, and the papillectomy morbidity results do not transfer directly to a non-specialised centre. Nothing here changes the recommended surveillance interval or Spigelman stage-based stratification.

Analysis by Dr Thibaut Benquey