Comparison of nonampullary duodenal adenomas in patients with familial adenomatous polyposis versus patients with sporadic adenomas

• Published in: Gastrointestinal endoscopy Vol. 85; no. 4; pp. 803 - 812
• Main Authors: Cassani, Lisa S., Lanke, Gandhi, Chen, Hsiang-Chun, Wang, Xuemei, Lynch, Patrick, Lee, Jeffrey H.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2017
• Subjects: Adenoma - pathology; Adenoma - surgery; Adenomatous Polyposis Coli - pathology; Adenomatous Polyposis Coli - surgery; Adult; Age Factors; Aged; Carcinoma - pathology; Carcinoma - surgery; Case-Control Studies; Disease Progression; Duodenal Neoplasms - pathology; Duodenal Neoplasms - surgery; Endoscopic Mucosal Resection; Female; Follow-Up Studies; Gastroenterology and Hepatology; Humans; Intestinal Polyps - pathology; Intestinal Polyps - surgery; Male; Middle Aged; Neoplasms, Multiple Primary - pathology; Neoplasms, Multiple Primary - surgery; Retrospective Studies; Tumor Burden; FAP; OS; overall survival; familial adenomatous polyposis
• ISSN: 0016-5107; 1097-6779; 1097-6779
• DOI: 10.1016/j.gie.2016.08.005

Nonampullary duodenal adenomas are either sporadic or associated with a hereditary syndrome such as familial adenomatous polyposis (FAP). The aim of this study is to compare characteristics and outcomes of sporadic and FAP-associated duodenal adenomas. We retrospectively collected clinical, endoscopic, and pathologic data in patients diagnosed with duodenal adenomas at our institution and included all available follow-up. Two hundred thirteen subjects were identified; 118 had FAP and 95 had sporadic adenomas. FAP subjects were more likely to have multifocal disease. Initial size was not significantly associated with dysplasia. Fourteen (12%) with FAP and 33 (35%) with sporadic adenomas underwent EMR. Among those subjects who did not undergo EMR or surgery, there was no difference between the FAP and sporadic groups with progression to new dysplasia or cancer. However, the FAP group was significantly more likely to have dysplasia at follow-up (P = .05). There was a significant difference in overall survival between the FAP and sporadic groups (log-rank test, P < .001). In the subgroup of patients aged 40 years old and older who did not undergo intervention, the FAP group had a shorter time to pathology progression compared with the similar sporadic subgroup. Range of time to progression to cancer was 3 to 161 months. FAP subjects were more likely to be younger and have multifocal disease. Progression of pathology was more likely in the older FAP group compared with the sporadic group. Time to progression to cancer was widely variable and, therefore, unpredictable.