ENDOSCOPIC MANAGEMENT OF DUODENAL AND JEJUNAL POLYPOSIS IN PATIENTS WITH FAMILIAL ADENOMATOUS POLYPOSIS USING DOUBLE BALLOON ENDOSCOPY

Aims:

It was reported that endoscopic treatment for colorectal polyposis can be considered in the management of Familial adenomatous polyposis (FAP) patients refusing colectomy. Despite the lifetime risk for duodenal and small bowel cancer is approximately 4%, prophylaxis is not discussed sufficiently. The aim of the study was to elucidate the long-term outcomes, safety and developing cancer after double balloon endoscopy (DBE)-assisted endoscopic treatment in FAP patients with duodenal and jejunal polyposis.

Methods:

We retrospectively reviewed 8 patients underwent endoscopic treatments more than two sessions using DBE from August 2004 to July 2018 at Jichi Medical University Hospital.

The following outcome were included:

1. clinical characteristics (age, sex, number of endoscopy, history of abdominal surgery);

2. results (procedure time, the number of resected polyps, maximum diameter of resected polyp, resection method, pathological consequence;

3. adverse events and development of small intestinal cancer.

Results:

A total of 72 DBEs were performed in these patients during the study period and 1237 polyps were resected. The mean number of DBEs per patient was 6 (range 3 – 28). The average age at the first examination of 8 patients (5 male and 3 female) was 31 (range 16 – 53 years). The median observation period was 77.5 months (8 to 167).

There were 11 adverse events, including 7 delayed bleedings and 4 acute pancreatitis. These bleeding episodes were treated successfully by endoscopic hemoclips and pancreatitis were managed conservatively.

No development of advanced duodenum or jejunal cancer was observed during the observation period, and only one intramucosal carcinoma was found in the duodenum in one patient.

Conclusions:

Endoscopic resection using DBE for duodenal and jejunal polyposis of FAP can be performed safely and effectively.