Feasibility of Cold Snare Polypectomy for Multiple Duodenal Adenomas in Patients with Familial Adenomatous Polyposis: A Pilot Study

Excerpt

Although the prognosis for patients with familial adenomatous polyposis (FAP) has improved because of preventive proctocolectomy, duodenal adenomas occur in up to 90 % of these patients [1]. The risk of developing duodenal cancer in patients with Spigelman stage IV disease (Table 1) is high at 7–36 % over follow-up periods of 7.6–10 years, compared with in patients with Spigelman stage 0–III disease, at 0.7 % over a similar period [2]. Duodenal, rather than colorectal, cancer is now the main cause of death in patients with FAP after preventive proctocolectomy [1]. Therefore, preventive duodenectomy is recommended for patients with Spigelman stage IV disease; however, duodenectomy is invasive and carries a high mortality risk [3]. As an alternative, endoscopic treatment for duodenal adenomas is theoretically effective in preventing duodenal cancer mortality in patients with FAP; however, while endoscopic treatment for duodenal lesions is less invasive than duodenectomy, it carries a greater risk of complications such as bleeding or perforation [4, 5]. …