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CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(10): E1308-E1314
DOI: 10.1055/a-1220-6699
Original article

Dye chromoendoscopy leads to a higher adenoma detection in the duodenum and stomach in patients with familial adenomatous polyposis

R. Hüneburg
1   Department of Internal Medicine I, University Hospital Bonn, Germany
2   National Center for Hereditary Tumor Syndromes, University Hospital Bonn, Germany
,
D. Heling
1   Department of Internal Medicine I, University Hospital Bonn, Germany
2   National Center for Hereditary Tumor Syndromes, University Hospital Bonn, Germany
,
D. J. Kaczmarek
1   Department of Internal Medicine I, University Hospital Bonn, Germany
,
P. van Heteren
1   Department of Internal Medicine I, University Hospital Bonn, Germany
2   National Center for Hereditary Tumor Syndromes, University Hospital Bonn, Germany
,
M. Olthaus
1   Department of Internal Medicine I, University Hospital Bonn, Germany
2   National Center for Hereditary Tumor Syndromes, University Hospital Bonn, Germany
,
R. Fimmers
3   Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), University Hospital Bonn, Germany
,
M. Berger
3   Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), University Hospital Bonn, Germany
,
C. Coch
4   Clinical study core unit (SZB), University Hospital Bonn, Germany
,
J. F. Lau
2   National Center for Hereditary Tumor Syndromes, University Hospital Bonn, Germany
5   Institute of Pathology, University Hospital Bonn, Germany
,
G. Kristiansen
2   National Center for Hereditary Tumor Syndromes, University Hospital Bonn, Germany
5   Institute of Pathology, University Hospital Bonn, Germany
,
T. J. Weismüller
1   Department of Internal Medicine I, University Hospital Bonn, Germany
,
I. Spier
2   National Center for Hereditary Tumor Syndromes, University Hospital Bonn, Germany
6   Institute of Human Genetics, University Hospital Bonn, Germany
,
S. Aretz
2   National Center for Hereditary Tumor Syndromes, University Hospital Bonn, Germany
6   Institute of Human Genetics, University Hospital Bonn, Germany
,
C. P. Strassburg‡
1   Department of Internal Medicine I, University Hospital Bonn, Germany
2   National Center for Hereditary Tumor Syndromes, University Hospital Bonn, Germany
,
J. Nattermann‡
1   Department of Internal Medicine I, University Hospital Bonn, Germany
2   National Center for Hereditary Tumor Syndromes, University Hospital Bonn, Germany
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Abstract

Backround and study aims Duodenal cancer is the cancer most often seen in patients with familial adenomatous polyposis (FAP) who have undergone risk-reducing colonic surgery. Almost all patients with FAP eventually develop duodenal adenomas and risk for duodenal cancer is up to 12 % with poor prognosis. In addition, there is a rising concern regarding increased gastric cancer risk in patients with FAP. Our aim was to enhance polyp detection by using CE (CE) with the application of indigo carmine dye.

Patient and methods We conducted a prospective, blinded study of patients with FAP undergoing endoscopic examination of the upper gastrointestinal tract. First, a standard white-light examination (WLE) was done followed by an examination performed by an endoscopist who was blinded to the previous examination, using chromoendoscopy (CE) (0.4 % indigo carmine dye).

Results Fifty patients were included in the study. Using WLE, a median number of 13 adenomas (range 0–90) was detected compared to 23 adenomas/patient (range 0–150; P < 0.0001) detected after staining, leading to a higher Spigelman stage in 16 patients (32 %; P = 0.0003). CE detected significantly more larger adenomas (> 10 mm) than WLE (12 vs. 19; P = 0.0391). In the gastric antral region, a median number of 0 adenomas (range 0–6) before and 0.5 adenomas (range 0–7) after staining (P = 0.0025) were detected.

Conclusion This prospective endoscopic trial, to our knowledge the largest in patients with FAP, showed a significant impact of CE on adenoma detection and therapeutic management in the upper gastrointestinal tract. This leads to more intensive surveillance intervals.



Publication History

Received: 24 April 2020

Accepted: 09 June 2020

Article published online:
22 September 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
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Comment to this article:

Endoscopy International Open – recently publishedEndoscopy 2020; 52(11): 1043-1043
DOI: 10.1055/a-1234-8564

 

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