Endoscopic treatment of severe duodenal polyposis as an alternative to surgery for patients with familial adenomatous polyposis

Background Patients with familial adenomatous polyposis (FAP) and severe (stage IV) duodenal polyposis are candidates for pancreaticoduodenectomy, which has high morbidity. Little information is available about the feasibility of therapeutic endoscopy for these patients. Objective To evaluate the long-term efficiency and risks of endoscopic therapy. Design Retrospective study. Setting A 2-referral center long-term cohort study. Patients Thirty-five FAP patients (15 men, mean age 48 years) presenting with stage IV duodenal polyposis were included. Patients had a mean Spigelman classification score of 9.8 points (range 9-12 points) at their first examination. Interventions Patients underwent a surveillance endoscopy, including lateral and axial viewing with chromoendoscopy while under sedation, along with 7 ± 4.8 therapeutic endoscopic sessions during a follow-up period of 9 ± 4.5 years (range 1-19 years) after their first endoscopy. Main Outcome Measurements Treatment modalities, adverse events, and efficiency (evolution of the Spigelman score) were reviewed. Results A total of 245 therapeutic endoscopies were performed and 15 adverse events (6%) occurred. During the follow-up period, Spigelman scores decreased in 95% of patients by 6 ± 2.2 points ( P = .002). Modeling analysis showed that the mean Spigelman score decreased by 60% after 150 months. Limitations Retrospective study and the duration of the follow-up, even though this is the longest follow-up reported in medical literature. Conclusion Endoscopic treatment of severe duodenal polyposis in patients with FAP produces few adverse events and allows efficient downstaging of the polyposis. Long-term follow-up data did not reveal a high risk of invasive duodenal cancer in these patients.