Endoscopy 2009; 41(8): 666-669
DOI: 10.1055/s-0029-1214980
Original article

© Georg Thieme Verlag KG Stuttgart · New York

High resolution endoscopy and the additional value of chromoendoscopy in the evaluation of duodenal adenomatosis in patients with familial adenomatous polyposis

E.  Dekker1 , K.  S.  Boparai1 , J.  W.  Poley2 , E.  M.  H.  Mathus-Vliegen1 , G.  J.  A.  Offerhaus3 , E.  J.  Kuipers2 , 4 , P.  Fockens1 , J.  Dees2
  • 1Department of Gastroenterology and Hepatology, Academic Medical Centre Amsterdam, The Netherlands
  • 2Department of Gastroenterology and Hepatology, Erasmus MC University, Rotterdam, The Netherlands
  • 3Department of Pathology, UMC Utrecht, The Netherlands
  • 4Department of Internal Medicine, Erasmus MC University, Rotterdam, The Netherlands
Further Information

Publication History

submitted10 February 2009

accepted after revision4 May 2009

Publication Date:
10 August 2009 (online)

Background and study aim: Duodenal polyposis occurs in approximately 90 % of patients with familial adenomatous polyposis (FAP) and 5 % – 10 % develop duodenal cancer. Novel imaging techniques may improve evaluation of duodenal polyposis using the Spigelman classification. We aimed to analyze the value of high resolution endoscopy (HRE) and the additional value of chromoendoscopy in the evaluation of duodenal polyposis in FAP.

Patients and methods: 43 FAP patients scheduled for surveillance endoscopy in two academic centers underwent gastroduodenoscopy with HRE forward- and side-viewing devices. After number and size of adenomas had been scored, indigo carmine 0.5 % was sprayed onto the mucosa, polyps were scored again and biopsies taken from the larger lesions. Subsequently, Spigelman classifications were assessed for pre- and post-staining.

Results: Before staining, a median of 16 adenomas per patient were detected compared with 21 adenomas after staining (P = 0.02). Staining led to upgrading of Spigelman stage in 5/43 patients (12 %). Using the side-viewing endoscope, ampullary enlargement was detected in 22 patients (51 %) of whom 18 (42 %) had histologically confirmed ampullary adenomas.

Conclusion: HRE has raised the quality of endoscopic imaging considerably. Consequently, re-evaluation of the original Spigelman classification system seems advisable. Chromoendoscopy further increases detection of duodenal adenomas in FAP but without considerable change in Spigelman stage. Ampullary adenomas are commonly found in FAP and are best visualized using a side-viewing endoscope. Therefore, a combination of forward-viewing HRE and chromoendoscopy with side-viewing endoscopy for the periampullary region seems useful for surveillance of duodenal adenomatosis in FAP.

References

  • 1 Nugent K P, Spigelman A D, Phillips R K. Life expectancy after colectomy and ileorectal anastomosis for familial adenomatous polyposis.  Dis Colon Rectum. 1993;  36 1059-1062
  • 2 Bjork J, Akerbrant H, Iselius L. et al . Periampullary adenomas and adenocarcinomas in familial adenomatous polyposis: cumulative risks and APC gene mutations.  Gastroenterology. 2001;  121 1127-1135
  • 3 Bulow S, Bjork J, Christensen I J. et al . Duodenal adenomatosis in familial adenomatous polyposis.  Gut. 2004;  53 381-386
  • 4 Groves C J, Saunders B P, Spigelman A D. et al . Duodenal cancer in patients with familial adenomatous polyposis (FAP): results of a 10 year prospective study.  Gut. 2002;  50 636-641
  • 5 Heiskanen I, Kellokumpu I, Jarvinen H. Management of duodenal adenomas in 98 patients with familial adenomatous polyposis.  Endoscopy. 1999;  31 412-416
  • 6 Burke C A, Beck G J, Church J M, van Stolk R U. The natural history of untreated duodenal and ampullary adenomas in patients with familial adenomatous polyposis followed in an endoscopic surveillance program.  Gastrointest Endosc. 1999;  49 358-364
  • 7 Matsumoto T, Iida M, Nakamura S. et al . Natural history of ampullary adenoma in familial adenomatous polyposis: reconfirmation of benign nature during extended surveillance.  Am J Gastroenterol. 2000;  95 1557-1562
  • 8 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
  • 9 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
  • 10 Vasen H F, Moslein G, Alonso A. et al . Guidelines for the clinical management of familial adenomatous polyposis (FAP).  Gut. 2008;  57 704-713
  • 11 Kiesslich R, Mergener K, Naumann C. et al . Value of chromoendoscopy and magnification endoscopy in the evaluation of duodenal abnormalities: a prospective, randomized comparison.  Endoscopy. 2003;  35 559-563
  • 12 Picasso M, Filiberti R, Blanchi S, Conio M. The role of chromoendoscopy in the surveillance of the duodenum of patients with familial adenomatous polyposis.  Dig Dis Sci. 2007;  52 1906-1909
  • 13 Moozar K L, Madlensky L, Berk T, Gallinger S. Slow progression of periampullary neoplasia in familial adenomatous polyposis.  J Gastrointest Surg. 2002;  6 831-837
  • 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 Nugent K P, Spigelman A D, Williams C B. et al . Surveillance of duodenal polyps in familial adenomatous polyposis: progress report.  J R Soc Med. 1994;  87 704-706
  • 16 Kudo S, Rubio C A, Teixeira C R. et al . Pit pattern in colorectal neoplasia: endoscopic magnifying view.  Endoscopy. 2001;  33 367-373
  • 17 Machida H, Sano Y, Hamamoto Y. et al . Narrow-band imaging in the diagnosis of colorectal mucosal lesions: a pilot study.  Endoscopy. 2004;  36 1094-1098
  • 18 Tischendorf J J, Wasmuth H E, Koch A. et al . Value of magnifying chromoendoscopy and narrow band imaging (NBI) in classifying colorectal polyps: a prospective controlled study.  Endoscopy. 2007;  39 1092-1096
  • 19 DaCosta R S, Andersson H, Cirocco M. et al . Autofluorescence characterisation of isolated whole crypts and primary cultured human epithelial cells from normal, hyperplastic, and adenomatous colonic mucosa.  J Clin Pathol. 2005;  58 766-774
  • 20 Haringsma J, Tytgat G N, Yano H. et al . Autofluorescence endoscopy: feasibility of detection of GI neoplasms unapparent to white light endoscopy with an evolving technology.  Gastrointest Endosc. 2001;  53 642-650
  • 21 Wang T D, van DJ , Crawford J M. et al . Fluorescence endoscopic imaging of human colonic adenomas.  Gastroenterology. 1996;  111 1182-1191
  • 22 Uchiyama Y, Imazu H, Kakutani H. et al . New approach to diagnosing ampullary tumors by magnifying endoscopy combined with a narrow-band imaging system.  J Gastroenterol. 2006;  41 483-490

E. DekkerMD, PhD 

Department of Gastroenterology and Hepatology
Academic Medical Center

Meibergdreef 9
1105 AZ, Amsterdam
The Netherlands

Fax: +31-20-6917033

Email: e.dekker@amc.uva.nl

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