Endoscopy 2007; 39(1): 52-57
DOI: 10.1055/s-2006-945116
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Feasibility of double-balloon enteroscopy-assisted chromoendoscopy of the small bowel in patients with familial adenomatous polyposis

K.  Mönkemüller1 , L.  C.  Fry1 , M.  Ebert1 , M.  Bellutti1 , M.  Venerito1 , C.  Knippig1 , S.  Rickes1 , P.  Muschke2 , C.  Röcken3 , P.  Malfertheiner1
  • 1Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany
  • 2Department of Human Genetics, Otto-von-Guericke University, Magdeburg, Germany
  • 3Department of Pathology, Otto-von-Guericke University, Magdeburg, Germany
Further Information

Publication History

submitted 8 February 2006

accepted after revision 5 October 2006

Publication Date:
25 January 2007 (online)

Background and study aims: Patients with familial adenomatous polyposis (FAP) are at increased risk of developing duodenal and jejunal adenocarcinomas. The aim of this study was to assess the usefulness of double-balloon enteroscopy- (DBE-) assisted chromoendoscopy for the detection and characterization of small-bowel polyps in patients with FAP.

Patients and methods: We performed a prospective evaluation of patients with clinically and genetically proved FAP who were enrolled in an endoscopic surveillance program. DBE was performed using a Fujinon intestinoscope (FN 450P 5/20; Fujinon Corp., Omiya, Japan), and chromoendoscopy was performed using indigo carmine. The severity of small bowel polyposis was based on the Spigelman-Saurin classification.

Results: Nine patients underwent DBE-assisted chromoendoscopy. Small-bowel polyps (including papillary adenomas) were detected in seven patients (88 %). The mean depth of small-bowel insertion was 180 cm (range 120 - 320 cm). The mean Spigelman-Saurin score was 4.6 (range 0 - 8). Jejunal polyps were detected in six patients (67 %). Chromoendoscopy aided in the detection of additional polyps in two patients. In one patient the polyps were flat and only visible with chromoendoscopy (biopsy confirmed these to be adenomas). Jejunal polyps and advanced neoplasms were more frequent in patients with APC gene mutations in exon 15. The following endoscopic therapies were performed: polypectomy (n = 1), duodenal mucosectomy (n = 1), and ablation therapy with argon plasma coagulation (n = 2).

Conclusions: DBE was found to be a helpful method for the evaluation of small-bowel polyps in patients with FAP. DBE-assisted chromoendoscopy was of further assistance for the detection of jejunal polyps.

References

  • 1 Cruz-Correa M, Giardiello F M. Familial adenomatous polyposis.  Gastrointest Endosc. 2003;  58 885-894
  • 2 Burke C A, Beck G J, Church J M. et al . The natural history of untreated duodenal and ampullary adenomas in patients with familial adenomatous polyposis followed in an endoscopic surveillance program.  Gastrointest Endosc. 1999;  49 358-364
  • 3 Fearnhead N S. Familial adenomatous polyposis and MYH.  Lancet. 2003;  362 5-6
  • 4 Domizio P, Talbot I C, Spigelman A D. et al . Upper gastrointestinal pathology in familial adenomatous polyposis: results from a prospective study of 102 patients.  J Clin Pathol. 1990;  43 738-743
  • 5 Spigelman A D, Williams C B, Talbot I C. et al . Upper gastrointestinal cancer in patients with familial adenomatous polyposis.  Lancet. 1989;  2 783-785
  • 6 Groves C J, Saunders B P, Spigelman A D. et al . Duodenal cancer in patients with familial adenomatous polyposis (FAP): results of a 10-year prospective study.  Gut. 2002;  50 636-641
  • 7 Saurin J C, Gutknecht C, Napoleon B. et al . Surveillance of duodenal adenomas in familial adenomatous polyposis reveals high cumulative risk of advanced disease.  J Clin Oncol. 2004;  22 493-498
  • 8 Offerhaus G J, Giardiello F M, Krush A J. et al . The risk of upper gastrointestinal cancer in familial adenomatous polyposis.  Gastroenterology. 1992;  102 1980-1982
  • 9 Schulmann K, Hollerbach S, Kraus K. et al . Value of capsule endoscopy for the detection of small-bowel polyps in patients with hereditary polyposis syndromes (FAP, PJS, FJP).  Gastroenterology. 2003;  124 A-550
  • 10 Rodriguez-Bigas M A, Penetrante R B, Herrera L. et al . Intraoperative small bowel enteroscopy in familial adenomatous and familial juvenile polyposis.  Gastrointest Endosc. 1995;  42 560-564
  • 11 Giardiello F M, Brensinger J D, Petersen G M. AGA technical review on hereditary colorectal cancer and genetic testing.  Gastroenterology. 2001;  121 198-213
  • 12 Saurin J C, Napoleon B, Gay G. et al . Endoscopic management of patients with familial adenomatous polyposis (FAP) following a colectomy.  Endoscopy. 2005;  37 499-501
  • 13 Burke C A, Santisi J, Church J. et al . The utility of capsule endoscopy small bowel surveillance in patients with polyposis.  Am J Gastroenterol. 2005;  100 1-5
  • 14 Yamamoto H, Yano T, Kita H. et al . New system of double-balloon enteroscopy for diagnosis and treatment of small intestinal disorders.  Gastroenterology. 2003;  125 1556-1557
  • 15 May A, Nachbar L, Wardak A. et al . Double-balloon enteroscopy: preliminary experience in patients with obscure gastrointestinal bleeding or chronic abdominal pain.  Endoscopy. 2003;  35 985-991
  • 16 Mönkemüller K, Weigt J, Treiber G. et al . Diagnostic and therapeutic impact of double-balloon enteroscopy.  Endoscopy. 2006;  38 67-72
  • 17 Ell C, May A, Nachbar L. et al . Push-and-pull enteroscopy in the small bowel using the double-balloon technique: results of a prospective European multicenter study.  Endoscopy. 2005;  37 613-616
  • 18 Matsumoto T, Moriyama T, Esaki M. et al . Performance of antegrade double balloon enteroscopy: comparison with push enteroscopy.  Gastrointest Endosc. 2005;  62 392-398
  • 19 May A, Nachbar L, Schneider M. et al . Push-and-pull enteroscopy using the double-balloon technique: method of assessing depth of insertion and training of the enteroscopy technique using the Erlangen Endo-Trainer.  Endoscopy. 2005;  37 66-70
  • 20 Yamamoto H, Kita H, Sunada K. et al . Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal diseases.  Clin Gastroenterol Hepatol. 2004;  2 1010-1016
  • 21 Kiesslich R, Neurath M F. Chromoendoscopy with indigocarmine improves the detection of adenomatous and nonadenomatous lesions in the colon.  Endoscopy. 2001;  33 1001-1006
  • 22 Brooker J C, Saunders B P, Shah S G. et al . Total colonic dye-spray increases the detection of diminutive adenomas during routine colonoscopy: a randomized controlled trial.  Gastrointest Endosc. 2002;  56 333-338
  • 23 Hurlstone D P, Cross S S, Slater R. et al . Detecting diminutive colorectal lesions at colonoscopy: a randomized controlled trial of pan-colonic versus targeted chromoendoscopy.  Gut. 2004;  53 376-380
  • 24 Saurin J C, Ligneau B, Ponchon T. et al . The influence of mutation site and age on the severity of duodenal polyposis in patients with familial adenomatous polyposis.  Gastrointest Endosc. 2002;  55 342-347
  • 25 Giardiello F M, Petersen G M, Piantadosi S. et al . APC gene mutations and extraintestinal phenotype of familial adenomatous polyposis.  Gut. 1997;  40 521-525
  • 26 Giardiello F M, Hamilton S R, Krush A J. et al . Treatment of colonic and rectal adenomas with sulindac in familial adenomatous polyposis.  N Engl J Med. 1993;  328 1313-1316
  • 27 Cruz-Correa M, Hyilind L M, Romans K E. et al . Long-term treatment with sulindac in familial adenomatous polyposis: a prospective cohort study.  Gastroenterology. 2002;  122 641-645
  • 28 Steinbach G, Lynch P M, Phillips R K. et al . The effect of celecoxib, a cyclooxygenase-2 inhibitor, in familial adenomatous polyposis.  N Engl J Med. 2000;  342 1946-1952
  • 29 Phillips R K, Wallace M H, Lynch P M. et al . A randomised, double blind, placebo controlled study of celecoxib, a selective cyclooxygenase 2 inhibitor, on duodenal polyposis in familial adenomatous polyposis.  Gut. 2002;  50 857-860

K. Mönkemüller, MD

Department of Gastroenterology, Hepatology and Infectious Diseases

Otto-von-Guericke University

Leipziger Str. 44

39120 Magdeburg

Germany

Fax: +49-391-6713105

Email: klaus.moenkemueller@medizin.uni-magdeburg.de