Impact of endoscopic treatment in severe duodenal polyposis: a national study in familial adenomatous polyposis patients

Background and aims The majority of patients with Familial Adenomatous Polyposis (FAP) develop duodenal adenomas with a risk of progression to duodenal cancer. Endoscopic management of FAP duodenal adenomas has been proposed as a less invasive option than surgery, but available data are still limited. Our aims were to assess the feasibility and safety of endoscopic treatment in duodenal polyposis and to evaluate its long-term efficacy in terms of recurrence and malignant degeneration. Methods FAP patients with stage IV duodenal polyposis were enrolled in 5 French centers as part of a national cohort and followed for a median period of 5.66 years (IQR 6.39). Primary outcomes were duodenal surgery-free and cancer-free survival. Two groups of patients were identified according to endoscopic procedures: Group 1: resection and or destruction (by argon plasma coagulation) of duodenal polyps and group 2: papillectomy. Results 58 patients were enrolled (29 men; median age 44 years). Endoscopic therapy was performed in 37 patients of group 1 and 19 of group 2, respectively. Duodenal cancer-free and surgery-free survivals were 95.8% at 5 years and 92.6% at 10 years, respectively. Four patients required surgery and 2 developed cancers. In the 58 patients, the calculated Spigelman score decreased from 9.24 points at entry to 6.35 at five years and then plateaued. Complications (mostly bleeding and perforation) occurred in 20 patients. Conclusion In this long-term cohort follow up, endoscopic treatment of patients with severe duodenal polyposis appears relatively safe and effective as an alternative to surgery for the prevention of cancer.