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. 2021 Aug;53(8):795-801.
doi: 10.1055/a-1265-2716. Epub 2020 Nov 5.

Gastric adenomas and their management in familial adenomatous polyposis

Isabel Martin  1   2 , Victorine H Roos  3 , Chukwuemeka Anele  1   2 , Sarah-Jane Walton  4 , Victoria Cuthill  1 , Noriko Suzuki  1 , Barbara A Bastiaansen  3 , Susan K Clark  1   2 , Alexander von Roon  5 , Evelien Dekker  3 , Andrew Latchford  1   2
Affiliations

Gastric adenomas and their management in familial adenomatous polyposis

Isabel Martin et al. Endoscopy. 2021 Aug.

Abstract

Background: Patients with familial adenomatous polyposis (FAP) are at increased risk of developing gastric adenomas. There is limited understanding of their clinical course and no consensus on management. We reviewed the management of gastric adenomas in patients with FAP from two centers.

Methods: Patients with FAP and histologically confirmed gastric adenomas were identified between 1997 and 2018. Patient demographics, adenoma characteristics, and management/surveillance outcomes were collected.

Results: Of 726 patients with FAP, 104 (14 %; 49 female) were diagnosed with gastric adenomas at a median age of 47 years (range 19 - 80). The median size of gastric adenomas was 6 mm (range 1.5 - 50); 64 (62 %) patients had adenomas located distally to the incisura. Five patients (5 %) had gastric adenomas demonstrating high-grade dysplasia (HGD) on initial diagnosis, distributed equally within the stomach. The risk of HGD was associated with adenoma size (P = 0.04). Of adenomas > 20 mm, 33 % contained HGD. Two patients had gastric cancer at initial gastric adenoma diagnosis. A total of 63 patients (61 %) underwent endoscopic therapy for gastric adenomas. Complications occurred in three patients (5 %) and two (3 %) had recurrence, all following piecemeal resection of large (30 - 50 mm) lesions. Three patients were diagnosed with gastric cancer at median follow-up of 66 months (range 66 - 115) after initial diagnosis.

Conclusions: We observed gastric adenomas in 14 % of patients with FAP. Of these, 5 % contained HGD; risk of HGD correlated with adenoma size. Endoscopic resection was feasible, with few complications and low recurrence rates, but did not completely eliminate the cancer risk.

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Conflict of interest statement

Prof. Dekker has received a research grant and equipment loans from FujiFilm. She has also received honoraria for consultancy work for FujiFilm, Olympus, Tillots, GI Supply, and CPP-FAP, and speaker fees from Olympus, Roche, and GI supply. All other authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Endoscopic appearances of gastric adenomas. a Proximal adenoma (high definition image with white light). b Proximal adenoma (high definition image with flexible spectral imaging color enhancement). c Distal antral adenoma (white-light imaging). d Distal antral adenoma (high definition images with narrow-band imaging).
Fig. 2
Fig. 2
Current local protocol for management of gastric adenomas in patients with familial adenomatous polyposis. EMR, endoscopic mucosal resection; ESD, endoscopic submucosal dissection; EMR*, knife-assisted EMR; FGP, fundic gland polyposis.
See this image and copyright information in PMC

Comment in

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