Management of Duodenal Adenomas in Familial Adenomatous Polyposis

Introduction

Familial adenomatous polyposis (FAP) is an uncommon inherited disease, found in about 1/8000 births, which leads to the development of adenomas throughout the glandular digestive mucosa. The main complication of this disease is colorectal cancer, which is prevented by prophylactic colectomy carried out in most patients during the third decade. After colectomy, these patients remain at risk for life-threatening complications related to the disease. The two major complications are desmoid tumors (mesenchymal, nonmalignant, mostly mesenteric, slow-growing tumors), and duodenal adenocarcinomas, mostly periampullary [1] [2] . These probably develop from duodenal adenomas, which are present in the large majority of FAP patients. In clinical practice, there is a strong contradiction between the recommended endoscopic surveillance of duodenal adenomas, which demonstrates their evolving nature, and the lack of therapeutic indications until the development of late-stage polyposis which may require pancreaticoduodenectomy.

References

• 1 Nugent K P, Spigelman A D, Phillips R K. Life expectancy after colectomy and iliorectal anastomosis for familial adenomatous polyposis.  Dis Colon Rectum. 1993;  36 1059-1062
• 2 Jagelman D G, DeCosse J J, Bussey H J. Upper gastrointestinal cancer in familial adenomatous polyposis.  Lancet. 1988;  1 1149-1151
• 3 Vasen H F, Bulow S, Myrhoj T, et al. Decision analysis in the management of duodenal adenomatosis in familial adenomatous polyposis.  Gut. 1997;  40 716-719
• 4 Arvanitis M L, Jagelman D G, Fazio V W, et al. Mortality in patients with familial adenomatous polyposis.  Dis Colon Rectum. 1990;  33 639-642
• 5 Nugent K P, Spigelman A D, Williams C B, et al. Surveillance of duodenal polyps in familial adenomatous polyposis: progress report.  J Royal Soc Med. 1994;  87 704-706
• 6 Spigelman A D, Williams C B, Talbot I C, et al. Upper gastrointestinal cancer in patients with familial adenomatous polyposis.  Lancet. 1989;  2 783-785
• 7 Nakatsubo N, Kashiwagi H, Okumura M, et al. Malignant change in a duodenal adenoma in familial adenomatous polyposis: report of a case.  Am J Gastroenterol. 1998;  93 1566-1568
• 8 Sawada T, Muto T. Familial adenomatous polyposis: should patients undergo surveillance of the upper gastrointestinal tract?.  Endoscopy. 1995;  27 6-11
• 9 Richard C S, Berk T, Bapat B V, et al. Sulindac for periampullary polyps in FAP patients.  Int J Colorectal Dis. 1997;  12 14-18
• 10 Nugent K P, Spigelman A D, Williams C B, et al. Follow-up in familial adenomatous polyposis.  Lancet. 1993;  341 1225
• 11 Iida M, Yao T, Itoh H, et al. Natural history of duodenal lesions in Japanese patients with familial adenomatosis coli (Gardner's syndrome).  Gastroenterology. 1989;  96 1301-1306
• 12 Kashiwagi H, Spigelman A D, Debinski H S, et al. Surveillance of ampullary adenomas in familial adenomatous polyposis.  Lancet. 1994;  344 1582
• 13 Beckwith P S, van Heerden J A, Dozois R R, et al. Prognosis of symptomatic duodenal adenomas in familial adenomatous polyposis.  Arch Surg. 1991;  126 825-827, discussion 7 - 8
• 14 Debinski H S, Spigelman A D, Hatfield A, et al. Upper intestinal surveillance in familial adenomatous polyposis.  Eur J Cancer. 1995;  31A 1149-1153
• 15 Spigelman A D, Hodgson S V, Thomson J P. Management of familial adenomatous polyposis.  Baillières Clin Gastroenterol. 1992;  6 75-94
• 16 Hirasawa R, Iishi H, Tatsuta M, et al. Clinicopathologic features and endoscopic resection of duodenal adenocarcinomas and adenomas with the submucosal saline injection technique.  Gastrointest Endosc. 1997;  46 507-513
• 17 Fenoglio C M, Kaye G I, Lane N. Distribution of human colonic lymphatics in normal, hyperplastic, and adenomatous tissue. Its relationship to metastasis from small carcinomas in pedunculated adenomas, with two case reports.  Gastroenterology. 1973;  64 51-66
• 18 Witteman B J, Janssens A R, Griffioen G, et al. Villous tumours of the duodenum. An analysis of the literature with emphasis on malignant transformation.  Neth J Med. 1993;  42 5-11
• 19 Iwama T, Tomita H, Kawachi Y, et al. Indications for local excision of ampullary lesions associated with familial adenomatous polyposis.  J Am Coll Surg. 1994;  179 462-464
• 20 Bjork K J, Davis C J, Nagorney D M, et al. Duodenal villous tumors.  Arch Surg. 1990;  125 961-965
• 21 Bleau B L, Gostout C J. Endoscopic treatment of ampullary adenomas in familial adenomatous polyposis.  J Clin Gastroenterol. 1996;  22 237-241
• 22 Penna C, Phillips R K, Tiret E, et al. Surgical polypectomy of duodenal adenomas in familial adenomatous polyposis: Experience of two European centres.  Br J Surg. 1993;  80 1027-1029
• 23 Causeret S, Francois Y, Griot J B, et al. Prophylactic pancreaticoduodenectomy for premalignant duodenal polyposis in familial adenomatous polyposis.  Int J Colorectal Dis. 1998;  13 39-42
• 24 Penna C, Bataille N, Balladur P, et al. Surgical treatment of severe duodenal polyposis in familial adenomatous polyposis.  Br J Surg. 1998;  85 665-668
• 25 Brunetaud J M, Mosquet L, Houcke M, et al. Villous adenomas of the rectum. Results of endoscopic treatment with argon and Nd : YAG lasers.  Gastroenterology. 1985;  89 832-837
• 26 Mathus-Vliegen E M, Tytgat G N. Analysis of failures and complications of neodymium : Yag laser photocoagulation in gastrointestinal tract tumors. A retrospective survey of 18 years' experience.  Endoscopy. 1990;  22 17-23
• 27 Low D E, Kozarek R A, Ball T J, et al. Nd-YAG laser photoablation of sessile villous and tubular adenomas of the colorectum.  Ann Surg. 1988;  208 725-732
• 28 Ghilain J M, Dive C. Endoscopic laser therapy for small villous adenomas of the duodenum.  Endoscopy. 1994;  26 308-310
• 29 Paraf F, Naveau S, Zourabichvili O, et al. Endoscopic laser therapy for duodenal villous adenoma.  Dig Dis Sci. 1989;  34 1466-1467
• 30 Ponchon T, Berger F, Chavaillon A, et al. Contribution of endoscopy to diagnosis and treatment of tumors of the ampulla of Vater.  Cancer. 1989;  64 161-167
• 31 van Stolk R, Sivak M V Jr, Petrini J L, et al. Endoscopic management of upper gastrointestinal polyps and periampullary lesions in familial adenomatous polyposis and Gardner's syndrome.  Endoscopy. 1987;  19 (Suppl. 1) 19-22
• 32 Mlkvy P, Messmann H, Debinski H, et al. Photodynamic therapy for polyps in familial adenomatous polyposis - a pilot study.  Eur J Cancer. 1995;  31A 1160-1165
• 33 Wahab P J, Mulder C J, den Hartog G, et al. Argon plasma coagulation in flexible gastrointestinal endoscopy: pilot experiences.  Endoscopy. 1997;  29 176-181
• 34 Yokota T, Sugihara K, Yoshida S. Endoscopic mucosal resection for colorectal neoplastic lesions.  Dis Colon Rectum. 1994;  37 1108-1111
• 35 Kudo S. Endoscopic mucosal resection of flat and depressed types of early colorectal cancer.  Endoscopy. 1993;  25 455-461
• 36 Binmoeller K F, Boaventura S, Ramsperger K, et al. Endoscopic snare excision of benign adenomas of the papilla of Vater.  Gastrointest Endosc. 1993;  39 127-131
• 37 Oohara T, Ogino A, Saji K, et al. Studies on the difference of background mucosa among single advanced carcinoma and benign diseases of the large intestine, and familial polyposis coli.  Cancer. 1980;  45 1637-1645
• 38 Strasberg S M, Drebin J A, Soper N J. Evolution and current status of the Whipple procedure: an update for gastroenterologists.  Gastroenterology. 1997;  113 983-994
• 39 Nyam D C, Brillant P T, Dozois R R, et al. Ileal pouch-anal canal anastomosis for familial adenomatous polyposis: early and late results.  Ann Surg. 1997;  226 514-519, discussion 9 - 21
• 40 Penna C P, Tiret E, Kartheuser A H, et al. Comparison of functional results of ileorectal and ileo-anal anastomoses in familial adenomatous polyposis. Conversions of ileorectal anastomoses into ileo-anal anastomoses.  Gastroenterol Clin Biol. 1992;  16 401-405
• 41 Piazza G A, Rahm A K, Finn T S, et al. Apoptosis primarily accounts for the growth-inhibitory properties of sulindac metabolites and involves a mechanism that is independent of cyclooxygenase inhibition, cell cycle arrest, and p53 induction.  Cancer Res. 1997;  57 2452-2459
• 42 Oshima M, Dinchuk J E, Kargman S L, et al. Suppression of intestinal polyposis in Apc delta716 knockout mice by inhibition of cyclooxygenase 2 (COX-2).  Cell. 1996;  87 803-809
• 43 Nugent K P, Farmer K C, Spigelman A D, et al. Randomized controlled trial of the effect of sulindac on duodenal and rectal polyposis and cell proliferation in patients with familial adenomatous polyposis.  Br J Surg. 1993;  80 1618-1619
• 44 Spagnesi M T, Tonelli F, Dolara P, et al. Rectal proliferation and polyp occurrence in patients with familial adenomatous polyposis after sulindac treatment.  Gastroenterology. 1994;  106 362-366
• 45 Giardiello F M, Hamilton S R, Krush A J, et al. Treatment of colonic and rectal adenomas with sulindac in familial adenomatous polyposis.  N Engl J Med. 1993;  328 1313-1316
• 46 Pasricha P J, Bedi A, O'Connor K, et al. The effects of sulindac on colorectal proliferation and apoptosis in familial adenomatous polyposis.  Gastroenterology. 1995;  109 994-998
• 47 Ishikawa H, Akedo I, Suzuki T, et al. Adverse effects of sulindac used for prevention of colorectal cancer.  J Natl Cancer Inst. 1997;  89 1381
• 48 Niv Y, Fraser G M. Adenocarcinoma in the rectal segment in familial polyposis coli is not prevented by sulindac therapy.  Gastroenterology. 1994;  107 854-857
• 49 Lynch H T, Thorson A G, Smyrk T, et al. Rectal cancer after prolonged sulindac chemoprevention. A case report.  Cancer. 1995;  75 936-938
• 50 Gossner L, Stolte M, Sroka R, et al. Photodynamic ablation of high-grade dysplasia and early cancer in Barrett's esophagus by means of 5-aminolevulinic acid.  Gastroenterology. 1998;  114 448-455
• 51 Regula J, MacRobert A J, Gorchein A, et al. Photosensitisation and photodynamic therapy of oesophageal, duodenal, and colorectal tumours using 5 aminolaevulinic acid induced protoporphyrin IX - a pilot study.  Gut. 1995;  36 67-75
• 52 Loh C S, Bliss P, Bown S G, et al. Photodynamic therapy for villous adenomas of the colon and rectum.  Endoscopy. 1994;  26 243-246
• 53 Lightdale C J, Heier S K, Marcon N E, et al. Photodynamic therapy for porfimer sodium versus thermal ablation therapy with Nd : YAG laser for palliation of esophageal cancer: a multicenter randomized trial.  Gastrointest Endosc. 1995;  42 507-512
• 54 Sibille A, Lambert R, Souquet J C, et al. Longterm survival after photodynamic therapy for esophageal cancer.  Gastroenterology. 1995;  108 337-344
• 55 Tajiri H, Daikuzono N, Joffe S N, et al. Photoradiation therapy in early gastrointestinal cancer.  Gastrointest Endosc. 1987;  33 88-90
• 56 Mlkvy P, Messmann H, Regula J, et al. Sensitization and photodynamic therapy (PDT) of gastrointestinal tumors with 5-aminolaevulinic acid (ALA) induced protoporphyrin IX (PPIX). A pilot study.  Neoplasma. 1995;  42 109-113
• 57 Mathus-Vliegen E M, Tytgat G N. The potential and limitations of laser photoablation of colorectal adenomas.  Gastrointest Endosc. 1991;  37 9-17