Small-intestinal involvement in familial adenomatous polyposis: evaluation by double-balloon endoscopy and intraoperative enteroscopy

• Published in: Gastrointestinal endoscopy 2008-11, Vol.68 (5), p.911-919
• Main Authors: Matsumoto, Takayuki, MD, Esaki, Motohiro, MD, Yanaru-Fujisawa, Ritsuko, MD, Moriyama, Tomohiko, MD, Yada, Shinichiro, MD, Nakamura, Shotaro, MD, Yao, Takashi, MD, Iida, Mitsuo, MD
• Format: Article
• Language: English
• Subjects: Adenomatous Polyposis Coli - diagnosis; Adenomatous Polyposis Coli - genetics; Adenomatous Polyposis Coli - pathology; Adenomatous Polyposis Coli - surgery; Adolescent; Adult; Aged; Biological and medical sciences; Catheterization; Child; Digestive system. Abdomen; Duodenal Neoplasms - diagnosis; Duodenal Neoplasms - genetics; Duodenal Neoplasms - pathology; Duodenal Neoplasms - surgery; Endoscopy; Endoscopy, Gastrointestinal - methods; Female; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Genes, APC; Humans; Intraoperative Period; Investigative techniques, diagnostic techniques (general aspects); Jejunal Neoplasms - diagnosis; Jejunal Neoplasms - genetics; Jejunal Neoplasms - pathology; Jejunal Neoplasms - surgery; Male; Medical sciences; Middle Aged; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Tumors; Young Adult
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2008.02.067

Background Small-intestinal adenoma occurs in patients with familial adenomatous polyposis (FAP). Objectives The aim was to analyze the diagnostic yield of a double-balloon endoscopy (DBE) and an intraoperative enteroscopy (IOE) for small-intestinal involvement in FAP. Patients Forty-one patients with FAP. Interventions We examined 12 patients with FAP by using oral DBE before a colectomy and 29 patients with FAP by using IOE. The incidence and the endoscopic findings of adenoma were compared between the 2 procedures. Phenotypes of FAP and genotypes of adenomatous polyposis coli ( APC ) were then compared between patients with small-intestinal adenomas and those without. The genotype was classified into a 5' mutation (exons 1-14), a 3' mutation (exon 15), and a negative mutation of APC. Main Outcome Measurement The prevalence of adenoma. Results A DBE detected small-intestinal adenomas in 9 of 12 patients (75%), as did an IOE in 15 of 29 patients (52%, P > .05). The adenomas occurred predominantly in the jejunum, with a configuration of diminutive polyps in 22 patients. In addition, a DBE detected nonpolypoid adenoma in a patient, and nodular, broad-based protrusion (advanced lesions) in 3 patients, whereas an IOE detected advanced lesions in a patient. Patients with small-intestinal adenoma had more severe duodenal adenomatosis than those patients without small-intestinal adenoma ( P < .001). In cases in which APC was analyzed, the prevalence of small-intestinal adenoma was higher in patients with a 3' mutation (100%) than in those with a 5' mutation (44%) and with a negative mutation (42%, P < .02). Limitation Not a prospective randomized study. Conclusions A DBE is equal to an IOE for scrutiny of small-intestinal adenomas in FAP. There seems to be a genotype-jejunal phenotype correlation in FAP.