Progression of duodenal adenomatosis in familial adenomatous polyposis: due to ageing of subjects and advances in technology

Elisabeth M H Mathus-Vliegen, Karam S Boparai, Evelien Dekker, Nan van Geloven, Elisabeth M H Mathus-Vliegen, Karam S Boparai, Evelien Dekker, Nan van Geloven

Abstract

Familial adenomatous polyposis patients are at risk of duodenal cancer. Surveillance is indicated and the extent of duodenal polyposis is quantified by the Spigelman staging system. We noticed an impressive increase in high Spigelman stages over the years and therefore decided to investigate whether this increase might be due to the time-lapse since the inception of surveillance or related to improvements in endoscopic imaging and/or changes in dysplasia-reporting. Patients who were investigated by the same endoscopist since 1980 in at least 2 different episodes of technical improvements were eligible. The period 1980-2009 was divided into 4 episodes using the following landmarks: replacement of fibre-endoscopes by video-endoscopes in 1987, change in processors in 1995, change in image resolution in 2000, and change in dysplasia-reporting in 2006. An increase in Spigelman stages from low stages (0-II 100%) to high stages (III 28.1%, IV 43.8%) was seen (median follow-up: 19.5 years). In patients who progressed, a median of 4 years elapsed before progression by one stage occurred and 7 years to progress by two stages. In a mixed-model analysis, both time-lapse and technical improvements were determinant factors for duodenal disease progression. When both factors were introduced in the model, the time-lapse as well as the change in image resolution and dysplasia-ranking contributed consistently in increasing Spigelman scores and stages. The impressive increase in severity of duodenal polyposis is determined by time-lapse, technological advances and change in dysplasia-reporting. These results might call for a revised Spigelman classification.

Figures

Fig. 1
Fig. 1
Mean Spigelman score over time and the influences of changes in equipment and pathology

References

    1. Brosens LA, Keller JJ, Offerhaus GJ, Goggins M, Giardiello FM. Prevention and management of duodenal polyps in familial adenomatous polyposis. Gut. 2005;54:1034–1043. doi: 10.1136/gut.2004.053843.
    1. Vasen HF, Moslein G, Alonso A, et al. Guidelines for the clinical management of familial adenomatous polyposis (FAP) Gut. 2008;57:704–713. doi: 10.1136/gut.2007.136127.
    1. Arvanitis ML, Jagelman DG, Fazio VW, Lavery IC, McGannon E. Mortality in patients with familial adenomatous polyposis. Dis Colon Rectum. 1990;33:639–642. doi: 10.1007/BF02150736.
    1. Gallagher MC, Phillips RK, Bulow S. Surveillance and management of upper gastrointestinal disease in Familial Adenomatous Polyposis. Fam Cancer. 2006;5:263–273. doi: 10.1007/s10689-005-5668-0.
    1. Jagelman DG, DeCosse JJ, Bussey HJ. Upper gastrointestinal cancer in familial adenomatous polyposis. Lancet. 1988;1:1149–1151. doi: 10.1016/S0140-6736(88)91962-9.
    1. Offerhaus GJ, Giardiello FM, Krush AJ, et al. The risk of upper gastrointestinal cancer in familial adenomatous polyposis. Gastroenterology. 1992;102:1980–1982.
    1. Bulow S, Bjork J, Christensen IJ, et al. Duodenal adenomatosis in familial adenomatous polyposis. Gut. 2004;53:381–386. doi: 10.1136/gut.2003.027771.
    1. Heiskanen I, Kellokumpu I, Jarvinen H. Management of duodenal adenomas in 98 patients with familial adenomatous polyposis. Endoscopy. 1999;31:412–416. doi: 10.1055/s-1999-41.
    1. Saurin JC, Gutknecht C, Napoleon B, et al. Surveillance of duodenal adenomas in familial adenomatous polyposis reveals high cumulative risk of advanced disease. J Clin Oncol. 2004;22:493–498. doi: 10.1200/JCO.2004.06.028.
    1. Vasen HF, Bulow S, Myrhoj T, et al. Decision analysis in the management of duodenal adenomatosis in familial adenomatous polyposis. Gut. 1997;40:716–719. doi: 10.1136/gut.40.6.716.
    1. Beckwith PS, van Heerden JA, Dozois RR. Prognosis of symptomatic duodenal adenomas in familial adenomatous polyposis. Arch Surg. 1991;126:825–827.
    1. Debinski HS, Spigelman AD, Hatfield A, Williams CB, Phillips RK. Upper intestinal surveillance in familial adenomatous polyposis. Eur J Cancer. 1995;31A:1149–1153. doi: 10.1016/0959-8049(95)00171-E.
    1. Griffioen G, Bus PJ, Vasen HF, Verspaget HW, Lamers CB. Extracolonic manifestations of familial adenomatous polyposis: desmoid tumours, and upper gastrointestinal adenomas and carcinomas. Scand J Gastroenterol Suppl. 1998;225:85–91.
    1. Groves CJ, Saunders BP, Spigelman AD, Phillips RK. Duodenal cancer in patients with familial adenomatous polyposis (FAP): results of a 10 year prospective study. Gut. 2002;50:636–641. doi: 10.1136/gut.50.5.636.
    1. Norfleet RG. Screening for upper gastrointestinal neoplasms in patients with familial adenomatous polyposis and Gardner’s syndrome. J Clin Gastroenterol. 1992;14:95–96. doi: 10.1097/00004836-199203000-00002.
    1. Nugent KP, Spigelman AD, Williams CB, Talbot IC, Phillips RK. Surveillance of duodenal polyps in familial adenomatous polyposis: progress report. J R Soc Med. 1994;87:704–706.
    1. Kadmon M, Tandara A, Herfarth C. Duodenal adenomatosis in familial adenomatous polyposis coli. A review of the literature and results from the Heidelberg Polyposis Register. Int J Colorectal Dis. 2001;16:63–75. doi: 10.1007/s003840100290.
    1. Spigelman AD, Williams CB, Talbot IC, Domizio P, Phillips RK. Upper gastrointestinal cancer in patients with familial adenomatous polyposis. Lancet. 1989;2:783–785. doi: 10.1016/S0140-6736(89)90840-4.
    1. Schlemper RJ, Riddell RH, Kato Y, et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut. 2000;47:251–255. doi: 10.1136/gut.47.2.251.
    1. Bulow S, Alm T, Fausa O, Hultcrantz R, Jarvinen H, Vasen H. Duodenal adenomatosis in familial adenomatous polyposis. DAF Project Group. Int J Colorectal Dis. 1995;10:43–46. doi: 10.1007/BF00337586.
    1. Lepisto A, Kiviluoto T, Halttunen J, Jarvinen HJ. Surveillance and treatment of duodenal adenomatosis in familial adenomatous polyposis. Endoscopy. 2009;41:504–509. doi: 10.1055/s-0029-1214719.
    1. Moozar KL, Madlensky L, Berk T, Gallinger S. Slow progression of periampullary neoplasia in familial adenomatous polyposis. J Gastrointest Surg. 2002;6:831–837. doi: 10.1016/S1091-255X(02)00062-8.
    1. Saurin JC, Ligneau B, Ponchon T, et al. The influence of mutation site and age on the severity of duodenal polyposis in patients with familial adenomatous polyposis. Gastrointest Endosc. 2002;55:342–347. doi: 10.1067/mge.2002.121882.
    1. Church JM, McGannon E, Hull-Boiner S, et al. Gastroduodenal polyps in patients with familial adenomatous polyposis. Dis Colon Rectum. 1992;35:1170–1173. doi: 10.1007/BF02251971.
    1. Noda Y, Watanabe H, Iida M, et al. Histologic follow-up of ampullary adenomas in patients with familial adenomatosis coli. Cancer. 1992;70:1847–1856. doi: 10.1002/1097-0142(19921001)70:7<1847::AID-CNCR2820700707>;2-C.
    1. Burke CA, Beck GJ, Church JM, van Stolk RU. 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. doi: 10.1016/S0016-5107(99)70013-1.
    1. Matsumoto T. Natural history of ampullary adenoma in familial adenomatous polyposis: reconfirmation of benign nature during extended surveillance. Am J Gastroenterol. 2000;95:1557–1562. doi: 10.1111/j.1572-0241.2000.02094.x.
    1. Alexander JR, Andrews JM, Buchi KN, Lee RG, Becker JM, Burt RW. High prevalence of adenomatous polyps of the duodenal papilla in familial adenomatous polyposis. Dig Dis Sci. 1989;34:167–170. doi: 10.1007/BF01536046.
    1. Bertoni G, Sassatelli R, Nigrisoli E, et al. High prevalence of adenomas and microadenomas of the duodenal papilla and periampullary region in patients with familial adenomatous polyposis. Eur J Gastroenterol Hepatol. 1996;8:1201–1206. doi: 10.1097/00042737-199612000-00013.
    1. Debinski HS, Trojan J, Nugent KP, Spigelman AD, Phillips RK. Effect of sulindac on small polyps in familial adenomatous polyposis. Lancet. 1995;345:855–856. doi: 10.1016/S0140-6736(95)92989-4.
    1. Iida M, Yao T, Itoh H, Watanabe H, Matsui T, Iwashita A, Fujishima M. Natural history of duodenal lesions in Japanese patients with familial adenomatosis coli (Gardner’s syndrome) Gastroenterology. 1989;96:1301–1306.
    1. Domizio P, Talbot IC, Spigelman AD, Williams CB, Phillips RK. Upper gastrointestinal pathology in familial adenomatous polyposis: results from a prospective study of 102 patients. J Clin Pathol. 1990;43:738–743. doi: 10.1136/jcp.43.9.738.
    1. Latchford AR, Neale KF, Spigelman AD, Phillips RKS, Clark SK. Features of duodenal cancer in patients with familial adenomatous polyposis. Clin Gastroenterol Hepatol. 2009;7:659–663. doi: 10.1016/j.cgh.2009.02.028.
    1. 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. doi: 10.1053/gast.2001.28707.
    1. Mathus-Vliegen EMH (2011) Reply. Jejunal cancer in patients with familial polyposis. Clin Gastroenterol Hepatol (in press)

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