Introduction: Over 90% of the patients with familial adenomatous polyposis (FAP) will develop duodenal adenomas. Aim: The aim of this study was to evaluate the effectiveness and safety of endoscopic excision of large duodenal adenomas in FAP patients. Methods: All FAP patients from a familial risk clinic submitted to endoscopic therapy for duodenal adenomas ≥10 mm between January 2010 and February 2021 were included. Results: From 151 FAP families, 22 patients (50 lesions) were included: 54.5% female; median follow-up 8.5 (IQR: 5.8–12.3) years after the first endoscopy. First therapeutic endoscopy occurred at a median age of 41.0 years (IQR: 33.0–58.2). Repeat therapeutic endoscopy was required in 54.5% of patients. Median size of the largest adenoma was 15 mm (IQR: 10–18 mm); resection was piecemeal in 63.1% and en bloc in the remaining. In 2 cases, the resection was incomplete (fibrosis due to previous resection and difficult positioning). Complications occurred in 6.3% of the resected lesions (4 patients): 2 immediate (bleeding, perforation); 4 in the first week (1 bleeding, 2 mild pancreatitis, 1 perforation requiring surgery; the latter two after ampullectomy). Histology revealed low-grade dysplasia adenomas in 90.1%; no adenocarcinomas were found. One patient with Spigelman stage IV disease not amenable to endoscopic control underwent elective duodenopancreatectomy (without duodenal cancer). Conclusion: Endoscopic surveillance and treatment of duodenal adenomas in FAP patients was safe and effective in the prevention of duodenal cancer.
GE Port J Gastroenterol

中文翻译：

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家族性腺瘤性息肉病十二指肠腺瘤的内镜治疗：一项回顾性队列研究

简介：超过 90% 的家族性腺瘤性息肉病 (FAP) 患者会发展为十二指肠腺瘤。目的：本研究的目的是评估内镜下切除 FAP 患者十二指肠大腺瘤的有效性和安全性。方法： 2010 年 1 月至 2021 年 2 月期间，来自一家家族性风险诊所的所有 FAP 患者都接受了十二指肠腺瘤 ≥ 10 mm 的内镜治疗。结果：来自 151 个 FAP 家庭，包括 22 名患者（50 个病灶）：女性占 54.5%；第一次内窥镜检查后的中位随访时间为 8.5（IQR：5.8-12.3）年。第一次治疗性内镜检查发生在中位年龄 41.0 岁 (IQR: 33.0–58.2)。54.5% 的患者需要重复治疗性内镜检查。最大腺瘤的中位大小为 15 mm（IQR：10-18 mm）；63.1% 的切除是零碎的，其余的是整块切除。2例切除不完全（因既往切除及定位困难导致纤维化）。并发症发生在 6.3% 的切除病灶（4 名患者）中：2 个立即发生（出血、穿孔）；第一周 4 例（1 例出血，2 例轻度胰腺炎，1 例穿孔需要手术；后 2 例在壶腹切除术后）。组织学显示 90.1% 为低度异型增生腺瘤；没有发现腺癌。结论： FAP患者十二指肠腺瘤的内镜监测和治疗对于预防十二指肠癌是安全有效的。
GE Port J 胃肠醇