Download PDF
Endoscopy 2008; 40(2): 120-125
DOI: 10.1055/s-2007-995363
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Frequency and severity of ileal adenomas in familial adenomatous polyposis after colectomy

D.  Moussata1 , S.  Nancey1 , M.  G.  Lapalus2 , B.  Prost2 , A.  Chavaillon2 , G.  Bernard2 , T.  Ponchon2 , J.  C.  Saurin1
  • 1Hôpital Lyon Sud, Pierre Bénite, France
  • 2Hôpital Edouard Herriot, Lyon, France
Further Information

Publication History

submitted 23 March 2007

accepted after revision 2 September 2007

Publication Date:
07 December 2007 (online)

Also available at
    Permissions and Reprints

See also:

Commentaire de travail de D. Moussata et al., pp. 120Endoscopy 2008; 40(02): 234-234
DOI: 10.1055/s-0032-1306808

Background and study aims: The high cumulative risk of colorectal cancer in patients with familial adenomatous polyposis (FAP) justifies prophylactic colectomy with either ileorectal (IRA) or ileal-pouch-anal anastomosis (IPAA). Our aim was to evaluate retrospectively the frequency of and time interval to adenoma development in the ileal mucosa of patients with both types of surgery.

Patients and methods: Retrospective study of 44 FAP patients with IRA (n = 21) and IPAA (n = 23). All patients were followed with a standardized procedure including chromoscopy and biopsies of visible polyps. In patients with IRA, specific attention was paid to the ileal mucosa above the anastomosis.

Results: In the IPAA group, 18/23 patients (78 %) presented with visible polyps [histology: 16 (70 %) had adenoma with low-grade dysplasia; 1 (4 %) had adenoma with high-grade dysplasia; 1 had normal mucosa]. The mean interval between colectomy and the diagnosis of adenoma was 4.7 ± 3.3 years. In the IRA group, 16/21 patients (77 %) presented visible polyps in the ileal mucosa [adenoma with low-grade dysplasia in 8 patients (38 %), with high-grade dysplasia in 2 (10 %), and lymphoid nodular hyperplasia in 6]. The mean interval between colectomy and adenoma diagnosis was significantly shorter in the IPAA than in the IRA group (4.76 ± 3.3 vs. 16.4 ± 8.5 years, P< 0.0001).

Conclusion: Our results show a high frequency of adenomas in the ileal mucosa of patients with IPAA and IRA (74 % and 48 % respectively), with evolution into high-grade dysplasia in 6.7 % of cases.

References

  • 1 Bussey H J, Veale A M, Morson B C. Genetics of gastrointestinal polyposis.  Gastroenterology. 1978;  74 1325-1330
    PubMedSearch in Google Scholar
  • 2 Bess M A, Adson M A, Elveback L R. et al . Rectal cancer following colectomy for polyposis.  Arch Surg. 1980;  115 460-467
    PubMedSearch in Google Scholar
  • 3 De Cosse J J, Bulow S, Neale K. et al . Rectal cancer risk in patients treated for familial adenomatous polyposis. The Leeds Castle Polyposis Group.  Br J Surg. 1992;  79 1372-1375
    PubMedSearch in Google Scholar
  • 4 Nugent K P, Phillips R K. Rectal cancer risk in older patients with familial adenomatous polyposis and an ileorectal anastomosis: a cause for concern.  Br J Surg. 1992;  79 1204-1206
    CrossrefPubMedSearch in Google Scholar
  • 5 Penna C, Tiret E, Kartheuser A. et al . Function of ileal J pouch-anal anastomosis in patients with familial adenomatous polyposis.  Br J Surg. 1993;  80 765-767
    CrossrefPubMedSearch in Google Scholar
  • 6 Madden M V, Neale K F, Nicholls R J. et al . Comparison of morbidity and function after colectomy with ileorectal anastomosis or restorative proctocolectomy for familial adenomatous polyposis.  Br J Surg. 1991;  78 789-792
    PubMedSearch in Google Scholar
  • 7 Kartheuser A H, Parc R, Penna C P. et al . Ileal pouch-anal anastomosis as the first choice operation in patients with familial adenomatous polyposis: a ten-year experience.  Surgery. 1996;  119 615-623
    PubMedSearch in Google Scholar
  • 8 Vasen H F, van Duijvendijk P, Buskens E. et al . Decision analysis in the surgical treatment of patients with familial adenomatous polyposis: a Dutch-Scandinavian collaborative study including 659 patients.  Gut. 2001;  49 231-235
    CrossrefPubMedSearch in Google Scholar
  • 9 Hamilton S R, Bussey H J, Mendelsohn G. et al . Ileal adenomas after colectomy in nine patients with adenomatous polyposis coli/Gardner’s syndrome.  Gastroenterology. 1979;  77 1252-1257
    PubMedSearch in Google Scholar
  • 10 Jarvinen H, Nyberg M, Peltokallio P. Upper gastrointestinal tract polyps in familial adenomatosis coli.  Gut. 1983;  24 333-339
    CrossrefPubMedSearch in Google Scholar
  • 11 Burt R W, Berenson M M, Lee R G. et al . Upper gastrointestinal polyps in Gardner’s syndrome.  Gastroenterology. 1984;  86 295-301
    PubMedSearch in Google Scholar
  • 12 Bertoni G, Sassatelli R, Nigrisoli E. et al . First observation of microadenomas in the ileal mucosa of patients with familial adenomatous polyposis and colectomies.  Gastroenterology. 1995;  109 374-380
    CrossrefPubMedSearch in Google Scholar
  • 13 Groves C J, Beveridge I G, Swain D J. et al . Prevalence and morphology of pouch and ileal adenomas in familial adenomatous polyposis.  Dis Colon Rectum. 2005;  48 816-823
    CrossrefPubMedSearch in Google Scholar
  • 14 Shepherd N A, Jass J R, Duval I. et al . Restorative proctocolectomy with ileal reservoir: pathological and histochemical study of mucosal biopsy specimens.  J Clin Pathol. 1987;  40 601-607
    CrossrefPubMedSearch in Google Scholar
  • 15 Myrhøj T, Bülow S, Mogensen A M. Multiple adenomas in terminal ileum 25 years after restorative proctocolectomy for familial adenomatous polyposis. Report of a case.  Dis Colon Rectum. 1989;  32 618-620
    CrossrefPubMedSearch in Google Scholar
  • 16 Nugent K P, Spigelman A D, Nicholls R J. et al . Pouch adenomas in patients with familial adenomatous polyposis.  Br J Surg. 1993;  80 1620
    PubMedSearch in Google Scholar
  • 17 Church J M, Oakley J R, Wu J S. Pouch polyposis after ileal pouch-anal anastomosis for familial adenomatous polyposis: report of a case.  Dis Colon Rectum. 1996;  39 584-586
    CrossrefPubMedSearch in Google Scholar
  • 18 Wu J S, McGannon E A, Church J M. Incidence of neoplastic polyps in the ileal pouch of patients with familial adenomatous polyposis after restorative proctocolectomy.  Dis Colon Rectum. 1998;  41 552-556
    CrossrefPubMedSearch in Google Scholar
  • 19 Parc Y R, Olschwang S, Desaint B. et al . Familial adenomatous polyposis: prevalence of adenomas in the ileal pouch after restorative proctocolectomy.  Ann Surg. 2001;  233 360-364
    CrossrefPubMedSearch in Google Scholar
  • 20 Thompson-Fawcett M W, Marcus V A, Redston M. et al . Adenomatous polyps develop commonly in the ileal pouch of patients with familial adenomatous polyposis.  Dis Colon Rectum. 2001;  44 347-353
    CrossrefPubMedSearch in Google Scholar
  • 21 Beveridge I G, Swain D J, Groves C J. et al . Large villous adenomas arising in ileal pouches in familial adenomatous polyposis: report of two cases.  Dis Colon Rectum. 2004;  47 123-126
    CrossrefPubMedSearch in Google Scholar
  • 22 Beart Jr R W, Fleming C R, Banks P M. Tubulovillous adenomas in a continent ileostomy after proctocolectomy for familial polyposis.  Dig Dis Sci. 1982;  27 553-556
    CrossrefPubMedSearch in Google Scholar
  • 23 Iida M, Itoh H, Matsui T. et al . Ileal adenomas in postcolectomy patients with familial adenomatosis coli/Gardner’s syndrome. Incidence and endoscopic appearance.  Dis Colon Rectum. 1989;  32 1034-1038
    CrossrefPubMedSearch in Google Scholar
  • 24 Johnson C D, White H. Colonic metaplasia with colonic-type polyps on an ileostomy stoma in polyposis coli. Report of a case.  Dis Colon Rectum. 1988;  31 405-407
    CrossrefPubMedSearch in Google Scholar
  • 25 Nakahara S, Itoh H, Iida M. et al . Ileal adenomas in familial polyposis coli. Differences before and after colectomy.  Dis Colon Rectum. 1985;  28 875-877
    CrossrefPubMedSearch in Google Scholar
  • 26 Stryker S J, Carney J A, Dozois R R. Multiple adenomatous polyps arising in a continent reservoir ileostomy.  Int J Colorectal Dis. 1987;  2 43-45
    CrossrefPubMedSearch in Google Scholar
  • 27 Slim R, Ponchon T, Chavaillon A. et al . Follow-up and laser Nd-Yag treatment of adenomas in the rectal stump of familial adenomatous polyposis patients: long term results [abstract].  Gastrointest Endosc. 2000;  51 AB 151
    PubMedSearch in Google Scholar
  • 28 Prost B, Poncet G, Scoazec J Y. et al . Unusual complications of argon plasma coagulation.  Gastrointest Endosc. 2004;  59 929-932
    CrossrefPubMedSearch in Google Scholar
  • 29 Bertario L, Russo A, Radice P. et al . Genotype and phenotype factors as determinants for rectal stump cancer in patients with familial adenomatous polyposis.  Ann Surg. 2000;  231 538-543
    CrossrefPubMedSearch in Google Scholar
  • 30 Vasen A, Van Der Luijt , Slors M. et al . Molecular genetic tests as a guide to surgical management of familial adenomatous polyposis.  Lancet. 1996;  348 433-435
    CrossrefPubMedSearch in Google Scholar
  • 31 Wu J, Paul P, Mc G annon. et al . APC genotype, polyp number and surgical options in familial adenomatous polyposis.  Ann Surg. 1998;  227 57-62
    CrossrefPubMedSearch in Google Scholar
  • 32 Saurin J C, Ligneau B, Ponchon . 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
    CrossrefPubMedSearch in Google Scholar
  • 33 Heiskanen I, Järvinen H J. Fate of rectal stump after colectomy and ileorectal anastomosis for familial adenomatous polyposis.  Int J Colorect Dis. 1997;  12 9-13
    CrossrefPubMedSearch in Google Scholar
  • 34 Tonelli F, Valanzano R, Monaci I. et al . Restorative proctocolectomy or rectum-preserving surgery in patients with familial adenomatous polyposis: results of a prospective study.  World J Surg. 1997;  21 63-65
    PubMedSearch in Google Scholar
  • 35 Valanzano R, Ficari F, Curia M C. et al . Balance between endoscopic and genetic information in the choice of ileorectal anastomosis for familial adenomatous polyposis.  J Surg Oncol. 2007;  95 28-33
    CrossrefPubMedSearch in Google Scholar
  • 36 O’Connell P R, Pemberton J H, Weiland L H. et al . Does rectal mucosa regenerate after ileoanal anastomosis?.  Dis Colon Rectum. 1987;  30 1-5
    PubMedSearch in Google Scholar
  • 37 Bassuini M M, Billings P J. Carcinoma in an ileoanal pouch after restorative proctocolectomy for familial adenomatous polyposis.  Br J Surg. 1996;  83 506
    CrossrefPubMedSearch in Google Scholar
  • 38 Brown S R, Donati D, Seow-Choen F. Rectal cancer after mucosectomy for ileoanal pouch in familial adenomatous polyposis: report of a case.  Dis Colon Rectum. 2001;  44 1714-1715
    PubMedSearch in Google Scholar
  • 39 Herbay A von, Stern J, Herfarth C. Pouch-anal cancer after restorative proctocolectomy for familial adenomatous polyposis.  Am J Surg Pathol. 1996;  20 995-999
    CrossrefPubMedSearch in Google Scholar
  • 40 Hoehner J C, Metcalf A M. Development of invasive adenocarcinoma following colectomy with ileoanal anastomosis for familial polyposis coli. Report of a case.  Dis Colon Rectum. 1994;  37 824-828
    PubMedSearch in Google Scholar

D. Moussata

Hôpital Lyon Sud

Service d’Hépato-gastro-entérologie

Chemin du Grand Revoyet

69495 Pierre Bénite

France

Fax: +04-78-863180

Email: driffa.moussata@chu-lyon.fr