Sa1090 Management of Non-Ampullary Duodenal Adenomas in Patients With Familial Adenomatous Polyposis (FAP) and Non-FAP Patients: Should We Manage Them Differently?

Abstract

Background: Non-ampullary duodenal adenomas are either sporadic or associated with a hereditary syndrome such as familial adenomatous polyposis (FAP). Duodenal adenomas are common in this syndrome, found in approximately 80 to 90% of patients. Objective: The aim of this study is to compare characteristics of sporadic and FAP-associated duodenal adenomas. Methods: This study was approved by the institutional review board. This was a retrospective review at a single center tertiary care institution. Subjects were identified from a pathological database. Subjects with ampullary adenomas only and with less than 2 month follow up were excluded. Data were obtained via review of medical records. Results: A total of 213 subjects were identified. Of those subjects, 117 subjects had FAP and the remainder were considered sporadic. Median age at diagnosis was 40 and 67 for subjects with FAP-associated adenomas and sporadic adenomas, respectively (P<0.0001). Length of follow up was 75±67 months for FAP subjects and 31±30 months for subjects with sporadic adenomas. At time of last follow up, 87.2% of those patients with FAP-associated adenomas had undergone colectomy versus 13% in the sporadic group. 52.1% of had ampullary involvement in addition compared to 7.3% in those subjects with sporadic adenomas (P<0.0001). FAP subjects were more likely to have multifocal disease within the duodenum (69% vs 33%, P<0.0001). On average FAP subjects underwent 6.5 endoscopies during the follow up period, and those with sporadic adenomas underwent 5.3 endoscopies. On initial pathology, there were 71 tubular adenomas (TA) and 46 tubulovillous adenomas (TVA), 15 of which had dysplasia (4 with low grade dysplasia (LGD) and 12 with high grade dysplasia (HGD)), within the FAP group. There were 48 TAs, 47 TVAs, and 1 villous adenoma, 14 of which had dysplasia (2 with LGD and 12 with HGD), in the sporadic group. 14 of 117 (12%) with FAP and 33 of 96 (34%) subjects with sporadic duodenal adenomas underwent endoscopic mucosal resection (EMR). Histologic progression to dysplasia or cancer was seen in 27 (23%) subjects with FAP and 13 (14%) with sporadic disease (P= 0.08). 6 patients within the cohort progressed to cancer, 2 within the FAP group and 4 within the sporadic group. Range of time to progression in those with cancer was 3 to 161 months. Median time to progression was 99.0 months in the FAP group and 122.2 months in the sporadic group. Conclusions: Those patients with FAP were significantly younger, more likely to have ampullary involvement, and more likely to have multifocal disease. Median time to progression to dysplasia or cancer as well as percent of subjects who progress is similar among FAP-associated and sporadic adenomas. Progression to cancer is infrequent, however unpredictable, and an interval for surveillance cannot be recommended given the current data.