Progression and Management of Duodenal Neoplasia in Familial Adenomatous Polyposis : A Cohort Study
OBJECTIVE: To describe the natural history and outcomes of surveillance of duodenal neoplasia in familial adenomatous polyposis (FAP).
BACKGROUND: Duodenal cancer is the most common cause of death in FAP.
METHODS: Cohort study of patients prospectively enrolled in an upper endoscopic surveillance protocol from 1982 to 2012. The duodenum was assessed by side-viewing endoscopy and classified as stage 1 to 5 disease. Endoscopic and/or operative interventions were performed according to stage.
RESULTS: There were 218 patients in the protocol (98 with advanced stage). They had a median of 9 endoscopies (range: 2-25) over a median of 11 years (range: 1-26). Median age at diagnosis of stage 3 disease (adenoma: 2.1-10 mm) was 41 years and stage 4 disease (adenoma >10 mm) was 45 years. Median time from first esophagogastroduodenoscopy to stage 4 disease was 22.4 years. The risk of stage 4 disease was 34.3% [95% confidence interval (CI) 23.8-43.4] at 15 years. In multivariate analysis, sex, type of colorectal surgery, years since colorectal surgery, and stage were significantly associated with risk of progression to stage 4 disease. Five of 218 (2.3%) patients developed duodenal cancer at median age of 58 years (range: 51-65). The risk of developing duodenal cancer was 2.1% (95% CI: 0-5.2) at 15 years.
CONCLUSIONS: Patients with advanced duodenal polyposis progress in the severity of disease (size and degree of dysplasia); however, the rate of progression to carcinoma is slow. Aggressive endoscopic and surgical intervention, especially in the presence of large polyps and high-grade dysplasia, appears to be effective in preventing cancer deaths in FAP.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2015 |
|---|---|
| Erschienen: |
2015 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:261 |
|---|---|
| Enthalten in: |
Annals of surgery - 261(2015), 6 vom: 23. Juni, Seite 1138-44 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Serrano, Pablo E [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
|---|
| Anmerkungen: |
Date Completed 28.04.2016 Date Revised 10.03.2022 published: Print Citation Status MEDLINE |
|---|
| doi: |
10.1097/SLA.0000000000000734 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM23938220X |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM23938220X | ||
| 003 | DE-627 | ||
| 005 | 20231224115828.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231224s2015 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1097/SLA.0000000000000734 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n0798.xml |
| 035 | |a (DE-627)NLM23938220X | ||
| 035 | |a (NLM)24950262 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Serrano, Pablo E |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Progression and Management of Duodenal Neoplasia in Familial Adenomatous Polyposis |b A Cohort Study |
| 264 | 1 | |c 2015 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 28.04.2016 | ||
| 500 | |a Date Revised 10.03.2022 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a OBJECTIVE: To describe the natural history and outcomes of surveillance of duodenal neoplasia in familial adenomatous polyposis (FAP) | ||
| 520 | |a BACKGROUND: Duodenal cancer is the most common cause of death in FAP | ||
| 520 | |a METHODS: Cohort study of patients prospectively enrolled in an upper endoscopic surveillance protocol from 1982 to 2012. The duodenum was assessed by side-viewing endoscopy and classified as stage 1 to 5 disease. Endoscopic and/or operative interventions were performed according to stage | ||
| 520 | |a RESULTS: There were 218 patients in the protocol (98 with advanced stage). They had a median of 9 endoscopies (range: 2-25) over a median of 11 years (range: 1-26). Median age at diagnosis of stage 3 disease (adenoma: 2.1-10 mm) was 41 years and stage 4 disease (adenoma >10 mm) was 45 years. Median time from first esophagogastroduodenoscopy to stage 4 disease was 22.4 years. The risk of stage 4 disease was 34.3% [95% confidence interval (CI) 23.8-43.4] at 15 years. In multivariate analysis, sex, type of colorectal surgery, years since colorectal surgery, and stage were significantly associated with risk of progression to stage 4 disease. Five of 218 (2.3%) patients developed duodenal cancer at median age of 58 years (range: 51-65). The risk of developing duodenal cancer was 2.1% (95% CI: 0-5.2) at 15 years | ||
| 520 | |a CONCLUSIONS: Patients with advanced duodenal polyposis progress in the severity of disease (size and degree of dysplasia); however, the rate of progression to carcinoma is slow. Aggressive endoscopic and surgical intervention, especially in the presence of large polyps and high-grade dysplasia, appears to be effective in preventing cancer deaths in FAP | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Grant, Robert C |e verfasserin |4 aut | |
| 700 | 1 | |a Berk, Terri C |e verfasserin |4 aut | |
| 700 | 1 | |a Kim, Dowan |e verfasserin |4 aut | |
| 700 | 1 | |a Al-Ali, Hassan |e verfasserin |4 aut | |
| 700 | 1 | |a Cohen, Zane |e verfasserin |4 aut | |
| 700 | 1 | |a Pollett, Aaron |e verfasserin |4 aut | |
| 700 | 1 | |a Riddell, Robert |e verfasserin |4 aut | |
| 700 | 1 | |a Silverberg, Mark S |e verfasserin |4 aut | |
| 700 | 1 | |a Kortan, Paul |e verfasserin |4 aut | |
| 700 | 1 | |a May, Gary R |e verfasserin |4 aut | |
| 700 | 1 | |a Gallinger, Steven |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Annals of surgery |d 1885 |g 261(2015), 6 vom: 23. Juni, Seite 1138-44 |w (DE-627)NLM000026654 |x 1528-1140 |7 nnns |
| 773 | 1 | 8 | |g volume:261 |g year:2015 |g number:6 |g day:23 |g month:06 |g pages:1138-44 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1097/SLA.0000000000000734 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 261 |j 2015 |e 6 |b 23 |c 06 |h 1138-44 | ||