Regression of Colonic Adenomas After Treatment With Sulindac in Familial Adenomatous Polyposis: A Case With a 2-Year Follow-up Without a Prophylactic Colectomy

Abstract

Familial adenomatous polyposis (FAP) is an autosomal dominant disorder characterized by hundreds of colorectal adenomatous polyps that progress to colorectal cancer. Management of patients with FAP is with a total colectomy. Chemopreventive strategies have been studied in FAP patients in an effort to delay the development of adenomas in the upper and the lower gastrointestinal tract and to prevent recurrence of adenomas in the retained rectum of patients after prophylactic surgery. Sulindac, a nonsteroidal anti-inflammatory drug, causes regression of colorectal adenomas in the retained rectal segment of FAP patients. However, evidence regarding long-term use of this therapy and its effect on the intact colon has been insufficient. We report a case in which the long-term use of sulindac was effective in reducing the size and the number of colonic polyps in patients with FAP without a prophylactic colectomy and polypectomy; we also present a review of the literature.

Keywords: Adenomatous polyposis coli; Chemoprevention; Sulindac; Therapy.

Fig. 1

Colonoscopy showed hundreds of polyps of various sizes carpeting the entire colon and rectum, which is consistent with familial adenomatous polyposis.

Fig. 2

After sulindac medication had been taken for 5 months, colonoscopy showed that the number and the size of polyps had been drastically decreased and that the polyps had almost completely disappeared.

Fig. 3

After sulindac medication had been taken for 25 months, colonoscopy showed several, sporadic, tiny polyps.